Impact of Her-2-Targeted Therapy on Overall Survival in Patients With Her-2 Positive Metastatic Breast Cancer

Abstract

Upon disease progression on trastuzumab-based therapy, patients with HER-2 positive metastatic breast cancer (MBC) may switch to lapatinib or continue on trastuzumab. We aimed to assess the impact of both strategies on overall survival (OS) in all patients treated for HER-2 positive MBC at the Medical University Vienna from 1999 until 2009. A total of 201 patients were identified from a breast cancer data base. Of these 115 (57.2%) received multiple lines of trastuzumab-based therapy, whereas 58 (28.9%) were treated with a single line. A control group of 28 patients (13.9%) had never received trastuzumab as they were treated before 1999, when trastuzumab was registered. OS from diagnosis of metastatic disease was defined as primary study endpoint. Trastuzumab significantly prolonged OS in HER-2 positive MBC (41 versus 13 months; p < 0.001). Administration of multiple lines further improved OS; this, however, did not reach statistical significance (47 versus 28 months; p = 0.069). Positive estrogen receptor (ER) status (HR 1.6; 95% CI 1.13-2.27) was associated with better outcome compared to negative estrogen receptor status (p = 0.02). Addition of lapatinib did not improve OS significantly in patients with prior trastuzumab-based therapy (62 versus 47 months; p = n.s.). Patients receiving lapatinib after diagnosis of BM, however, experienced an improvement of OS (22 versus 5 months; p = 0.022). Trastuzumab improves OS in patients with HER-2 positive MBC with further nonsignificant improvement when administered in multiple lines. Lapatinib did not further improve OS in the entire population; however, lapatinib might improve OS in patients with BM.

Use of trastuzumab for HER2-positive metastatic breast cancer in daily practice

“…Other observational studies reported similar rates [28][29][30][31]. Possibly combining treatment with a taxane was not preferred, given its toxicity profile, or because of the need for weekly intravenous therapy.…”

Early detection of metastatic disease in asymptomatic breast cancer patients with whole-body imaging and defined tumour marker increase

“…In addition, molecular subtypes of breast cancers have been identified with different OS rates and risk for developing metastasis ( Kennecke et al , 2010 ; Metzger-Filho et al , 2013 ; Minicozzi et al , 2013 ). Furthermore, new loco-regional therapy regimes, such as radiofrequency ablation, SIRT of the liver as well as systemic new therapies showed a significant impact on disease progression and OS ( Livraghi et al , 2001 ; Andre et al , 2004 ; Mack et al , 2004 ; Baselga et al , 2012a , 2012b ; Berghoff et al , 2013 ). Thus, our rationale was to test the most sensitive laboratory tests, that is, tumour marker increase from individual baseline values as well as high-resolution whole-body imaging with MRI and FDG-PET/CT for the detection of early metastasis in primarily asymptomatic patients at an early stage.…”

Triple negative breast cancer in a poor resource setting in North-Western Tanzania: a preliminary study of 52 patients

“…Lumina A tumors were found in 34.6% of the patients who could only benefit from hormonal therapy as they are negative for HER-2. Studies have shown that patients with positive ER had a much better response with trastuzumab than ER negative patients [23]; this includes patients with lumina B which comprised only 17.3% of our patients. Other studies demonstrated that the use of trastuzumab was associated with a longer time to occurrence of brain metastasis; even after brain metastasis, the use of this therapy showed a survival benefit [24].…”