PSA test not recommended by Canadian Task Force

PSA test not recommended by Canadian Task Force

News Long-term follow-up of two trials of the addition of trastuzumab to chemotherapy for patients with early HER2-positive breast cancer continue to...

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Long-term follow-up of two trials of the addition of trastuzumab to chemotherapy for patients with early HER2-positive breast cancer continue to show improvements in overall and disease-free survival in patients after a median of 8·4 years’ follow-up. The two trials included 4046 patients who were HER2-positive. After completion of doxorubicin and cyclophosphamide chemotherapy, some patients were randomly assigned to receive trastuzumab plus paclitaxel then trastuzumab alone to complete a year of therapy, whereas others were randomly assigned a regimen that did not contain trastuzumab. A joint analysis of these trials, led by Edith Perez and colleagues, suggests that patients given trastuzumab after chemo therapy had better overall survival than those given trastuzumab (hazard ratio [HR] 0·63 [95% CI

0·54–0·73]; p<0·001; 10-year overall survival 84% vs 75·2%, respectively). Women receiving trastuzumab also showed improvements in disease-free survival (HR 0·60 [95% CI 0·53–0·68]; p<0·001; 10-year disease-free survival 73·7% vs 62·2% in the control group). Distant recurrence occurred in 416 (20·6%) of 2018 women in the control group, and 241 (11·9%) of 2028 women in the trastuzumab group. Women in all subgroups showed improvements irrespective of age, node status (positive or negative), and oestrogen-receptor staus. “We knew at 2 years that trastuzumab increased overall survival, but these new results are important because they show increased benefit over the long term”, said Lisa Sclafani, an attending surgeon at Memorial Sloan-Kettering Cancer Center (New York, NY, USA). “This type of trial is somewhat rare

in its long follow-up, but crucial, as it determines whether preliminary benefit really translates into longterm effects for patients”, she added. “These results are really good news, and are congruent with other studies, such as the HERA and BCIRG-6 trials, which show that there is a benefit of continuing treatment for a full year, no more and no less”, said author Nancy E Davidson (University of Pittsburgh Cancer Institute and Medical Cancer Centers, Pennsylvania, PA, USA). “One of the reasons we did this trial is to see if our results back up the standard of care”, said primary investigator Edith Perez (Mayo Clinic Cancer Center, Jacksonville, FL, USA). She added, “we saw that preliminary results translated into long-term positive effects for patients.”

Steve Gschmeissner/Science Photo Library

Adjuvant trastuzumab improves survival in early breast cancer

Published Online October 31, 2014 http://dx.doi.org/10.1016/ S1470-2045(14)71110-6 For the study by Perez and colleagues see J Clin Oncol 2014; published online Oct 20. DOI:10.1200/JCO.2014.55.5730

Vicki Brower

PSA test not recommended by Canadian Task Force Prostate-specific antigen (PSA) testing should not be used to screen for prostate cancer as the potential harms of false positives, overdiagnosis, and unnecessary treatment far outweigh the benefits, announced the Canadian Task Force on Preventive Health Care. In an update to their 1994 guidelines, the independent panel did a systematic evidence review before concluding that PSA testing resulted in only a small reduction in prostate cancer mortality in men, especially in men aged younger than 55 years and aged older than 70 years. This conclusion also applies to men who are regarded as at high risk of prostate cancer, such as those with a family history of this disease. Overall, the risks associated with PSA testing were too high to justify its use. For men with prostate cancer who were diagnosed through PSA screening, about 11·3–19·8% will

receive a false-positive diagnosis, and 40–56% will be affected by overdiagnosis leading to invasive treatment, such as surgery. This surgery can lead to postoperative complications such as infection, urinary incontinence, erectile dysfunction, and others. More serious complications than those already stated occurred in 21 men per 1000 (2·1% [95% CI 1·6–2·5]). Neil Bell, of the Canadian Task Force (Calgary, AB, Canada), concluded that the recommendations balanced the possible benefits of PSA screening with the potential harms of false positives, overdiagnosis, and treatment of prostate cancer. Findings from the Canadian Task Force accord with recommendations from the US Preventive Services Task Force and the UK National Screening Committee. Anne Mackie, of the UK National Screening Committee

www.thelancet.com/oncology Vol 15 December 2014

(London, UK), said “The UK [committee] reviewed the evidence for a population-based screening programme for prostate cancer in 2010, and recommended against screening all men for the disease”. “Offering a formal screening programme to all men would result in thousands being exposed to unnecessary worry and treatment, with many having surgery that could result in incontinence or impotence.” However, Stuart Edmonds, Prostate Cancer Canada (Toronto, ON, Canada), stated “You can’t abandon PSA testing when research has shown that it is useful, particularly in the absence of anything better. We believe that when the results are properly interpreted, the benefits of PSA screening outweigh the risks of not screening men for prostate cancer.”

Published Online October 31, 2014 http://dx.doi.org/10.1016/ S1470-2045(14)71111-8 For the full guidelinesof the Canadian Task Force see CMAJ 2014; published online Oct 27. DOI:10.1503/cmaj.140703

Sanjay Tanday e589