Continuing trastuzumab beyond disease progression: outcomes analysis in patients with metastatic breast cancer

Cancello, Giuseppe; Montagna, Emilia; D’Agostino, Diana; Giuliano, Mario; Giordano, Antonio; Lorenzo, Giuseppe Di; Plaitano, Monica; Placido, Sabino De; Laurentiis, Michelino De

doi:10.1186/bcr2119

Cited by 54 publications

(41 citation statements)

References 25 publications

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“…While a number of retrospective analyses have shown a potential advantage for the "continuation policy" (reviewed in [3][4][5][6]) in agreement with our results, two retrospective studies indicated no statistically significant benefit from continuing trastuzumab [17,6]. In these studies, carried out by the same group, the authors themselves suggest that patients continuing trastuzumab might have been subject to closer clinical evaluation because of the weekly administration schedule of the antibody compared to the control arm of untreated patients, and an earlier detection of disease progression may have partially clouded the benefit of continuation.…”

Section: Discussionmentioning

confidence: 99%

“…However, patients may develop resistance to trastuzumab and show metastatic disease progression. Several retrospective studies published thus far (reviewed in [3,4]) [5,6] have indicated a certain overall response rate, clinical benefit and extended time to progression from the use of a second trastuzumabcontaining regimen in HER2-positive MBC patients who progressed on first-line trastuzumab treatment. Moreover, two recent randomized trials designed to directly evaluate the efficacy of continuing trastuzumab after progression demonstrated the potential clinical utility of continuing trastuzumab even for patients with progressive disease [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Increased overall survival independent of RECIST response in metastatic breast cancer patients continuing trastuzumab treatment: evidence from a retrospective study

Campiglio

Bufalino

Sandri

et al. 2011

Breast Cancer Res Treat

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ResultsOf the 272 HER2-positive MBC patients, 154 (56.6%) continued treatment. 79 (51.3%) of those 154 patients showed responses based on RECIST criteria during first-line trastuzumab-treatment.Of the 118 patients that suspended trastuzumab, RECIST responses had been observed in 44 (37.3%). Cox proportional hazards analysis of progressed patients, matched using propensity score, showed that discontinuation of trastuzumab at metastatic disease progression was a risk factor for significantly reduced overall survival in both responder (HR = 2.23; 95% CI = 1.03 to 4.82) and non-responder groups (HR = 3.53, 95% CI = 1.73 to 7.21), with no significant differences in the two estimated HRs (p-value of the likelihood-ratio test = 0.690). 4 ConclusionsContinued trastuzumab treatment after disease progression has clinically and statistically significant effects in both RECIST responder and non-responder MBC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Increased overall survival independent of RECIST response in metastatic breast cancer patients continuing trastuzumab treatment: evidence from a retrospective study

Campiglio

Bufalino

Sandri

et al. 2011

Breast Cancer Res Treat

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“…Prospective studies (Stemmler et al, 2005;Cancello et al, 2008;Extra et al, 2010) have shown that continuation of anti-HER2 therapies in patients progressing after trastuzumab-based treatment was associated with improved response rates and improved survival in HER2-positive MBC patients. Also in prospective randomized phase III studies (von Minckwitz et al, 2009;Blackwell et al, 2010), trastuzumab combination with capecitabine or lapatinib resulted in improved progression free survival compared to single agent capecitabine or lapatinib.…”

Section: Discussionmentioning

confidence: 99%

Trastuzumab-based Retreatment after Lapatinib in Heavily Pretreated HER2 Positive Metastatic Breast Cancer: an Anatolian Society of Medical Oncology Study

Uncu¹,

Bayoğlu²,

Arslan³

et al. 2015

Asian Pacific Journal of Cancer Prevention

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Background: For HER2 positive metastatic breast cancer (MBC), continuing anti-HER2 therapy beyond progression is associated with improved outcome. However retreatment with trastuzumab after lapatinib progression is controversial. We retrospectively analyzed the efficacy of trastuzumab-based chemotherapy in HER2+ metastatic breast cancer patients whose disease progressed after lapatinib. Materials and Methods: Between October 2010 and May 2013, 54 patients whose disease progressed after lapatinib were retreated with trastuzumab-based chemotherapy. Efficacy and toxicity results were evaluated retrospectively. Results: The median age of patients was 46 (range 27-67). Fourteen patients (26%) had metastases at the time of diagnosis. All of the patients had received trastuzumab in an adjuvant or metastatic setting, while 16 (30%) had received two lines of trastuzumab. All patients had received lapatinib plus capecitabine. The median chemotherapy line for the metastatic setting was 2 (range 1-7). Cranial metastases were identified in 27 (50%) patients. 53 patients received trastuzumab-based chemotherapy following lapatinib progression while one patient received trastuzumab monotherapy. Combination chemotherapy consisted of navelbin (n=33), taxane (n=10), gemcitabine (n=2), platinum (n=2) and platinum with taxane (n=6). The median treatment cycle was 5 (range 1-44). Among 49 patients assessed for response 2 (4%) showed CR, 12 (25%) PR, 11 (22%) SD and 24 (49%) disease progression. Asymptomatic cardiotoxicity was reported in 2 (4%) of the patients. At a median follow-up of 9 months (1-39), median progression-free survival was 5 months (95% CI 4.1-5.9) and median overall survival was 10 months (95% CI 6.9-13.0). PFS and OS were not affected by the absence/presence of cranial metastases. Conclusions: Retreatment with trastuzumab-based therapy after lapatinib progression showed efficacy in heavily treated MBC patients.

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“…In the past, options included stopping trastuzumab in favor of chemotherapy, or the more common clinical practice of continuing trastuzumab while changing its chemotherapeutic partner. This was based on empirical and retrospective data suggesting that trastuzumab retains its antitumor activity beyond progression [4,5]. The first randomized trial to confirm these findings was the GBG-26 (trastuzumab beyond progression) study which randomized patients with metastatic Her-2/neu-positive breast cancer, who progressed under first-line trastuzumab-based therapies to capecitabine +/-trastuzumab.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Partial Remission with Capecitabine/ Trastuzumab in a Patient with Metastatic Breast Cancer Following Progression on Trastuzumab Alone

et al. 2012

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Background: Since the introduction of trastuzumab into the treatment of Her-2/neu-positive metastatic breast cancer, cases of long-term survival have become more frequent. Even after tumor progression, trastuzumab seems to retain its antitumor activity which is potentiated by the combination with a chemotherapeutic agent. Case Report: We are reporting about the unusual clinical course of a young patient with Her-2/neu-positive breast cancer, who experienced progression of pulmonary and bone metastases under treatment with trastuzumab. Upon progression, a combination therapy with capecitabine/trastuzumab was initiated, and a partial remission was achieved which has continued for over 4 years. Conclusion: This unusual clinical course shows that continuing trastuzumab-based therapy beyond progression is a safe, effective, and well-tolerated option which can induce long-term remissions in some patients with Her-2/neu-positive metastatic breast cancer.

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Continuing trastuzumab beyond disease progression: outcomes analysis in patients with metastatic breast cancer

Cited by 54 publications

References 25 publications

Increased overall survival independent of RECIST response in metastatic breast cancer patients continuing trastuzumab treatment: evidence from a retrospective study

Increased overall survival independent of RECIST response in metastatic breast cancer patients continuing trastuzumab treatment: evidence from a retrospective study

Trastuzumab-based Retreatment after Lapatinib in Heavily Pretreated HER2 Positive Metastatic Breast Cancer: an Anatolian Society of Medical Oncology Study

Long-Term Partial Remission with Capecitabine/ Trastuzumab in a Patient with Metastatic Breast Cancer Following Progression on Trastuzumab Alone

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