Patients who achieved long-term clinical complete response and subsequently terminated multidisciplinary and anti-HER2 therapy for metastatic breast cancer: A case series

Takuwa, Haruko; Tsuji, Wakako; Yotsumoto, Fumiaki

doi:10.1016/j.ijscr.2018.10.008

Cited by 5 publications

(3 citation statements)

References 34 publications

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“…This PFS of nearly 46 months is markedly superior to the median PFS reported in the EMILIA trial (9.6 months) 8. Although termination of systemic therapy in selected patients with MBC showing long-term remission after anti-HER2 therapy has been reported,10 there is still no evidence that systemic therapy can be safely terminated after a specific time period. In this case, given the sustained response to treatment with minimal toxicity, we find that the patient should maintain treatment until progression or unmanageable adverse effects, as suggested by the available literature.…”

Section: Discussionmentioning

confidence: 66%

Three-year remission of metastatic breast cancer with treatment with ado-trastuzumab emtansine

Caramujo,

Reis,

Garcia

et al. 2023

BMJ Case Rep

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Globally, breast cancer is the most frequently diagnosed malignancy and the leading cause of oncological death in women. Metastatic disease at diagnosis (de novo stage IV breast cancer) will be identified in about 5% of patients. Treatment options vary based on several factors, namely whether the tumour is hormone receptor positive and whether human epidermal growth factor receptor 2 (HER2) is overexpressed. Here, we report a case of HER2 positive metastatic breast cancer on a woman in her late 30s, with remission for over 3 years under second-line treatment with ado-trastuzumab emtansine, with no significant toxicity and good tolerability. The timing to stop treatment under these circumstances presents a challenge and more data are needed to substantiate the decision to stop or maintain treatment in this small population.

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Section: Discussionmentioning

confidence: 66%

Three-year remission of metastatic breast cancer with treatment with ado-trastuzumab emtansine

Caramujo,

Reis,

Garcia

et al. 2023

BMJ Case Rep

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“…Trastuzumab treatment was terminated in 27 patients who received a median of 5.1 years of trastuzumab-based therapy, and progression was observed in 4 (14.8%) of the patients with a median follow-up of 3.9 years. In the case series of four diseases published by Takuwa et al, after clinical complete response to trastuzumab-based therapy, patients continued trastuzumab for 1–5 years as maintenance, and recurrence did not occur in the patients after 8–128 months of follow-up 20 . Also, in a letter to the editor published by Butterbaugh et al, cases published in the literature were pooled, and data from eight patients who achieved a durable complete response to trastuzumab-based therapy were shared; it was determined that complete response could continue for more than 12 years after the discontinuation of trastuzumab treatment 21 .…”

Section: Discussionmentioning

confidence: 96%

Termination of trastuzumab in HER2-positive metastatic breast cancer patients who received trastuzumab beyond progression

Doğan

Aydın

Khanmammadov

et al. 2023

Sci Rep

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The purpose of the study was to assess the prognosis of HER2-positive metastatic breast cancer patients who received trastuzumab beyond progression and investigate the predictors of complete response. HER2-positive metastatic breast cancer patients who received long-term trastuzumab were included in the study. Predictors of complete response were analyzed with binary regression analysis. The prognosis of patients who had their trastuzumab-based treatment terminated was assessed. Eighty patients were involved in the study. The patients were received with trastuzumab for a median of 62 months (12–191). A complete response was observed in 60 (75%) patients. The median duration to development of complete response was found as 14.8 months (2.4–55). In logistic regression analysis: using endocrine therapy with trastuzumab (p = 0.04), menopausal status (p = 0.03), and the number of metastatic sites (p = 0.01) were found to be statistically significant factors for a complete response. Trastuzumab-based therapy of fifteen patients was terminated, six (40%) patients continued to receive an aromatase inhibitor, and nine (60%) patients were followed up without treatment. After termination of trastuzumab, at a median follow-up of 32 months (11–66), recurrence was detected in two (13.3%) patients. We detected that menopausal status, the number of metastatic sites, and using endocrine therapy with trastuzumab were predictors of complete response in HER2-positive metastatic breast cancer patients who received long-term trastuzumab-based therapy. We observed that HER2-positive metastatic breast cancer patients may be completely cured with trastuzumab-based therapy. There are no defined criteria for termination of trastuzumab treatment in this selected patient group. It is necessary to confirm our data with multicenter studies involving a large number of patients.

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“…Although the standard rst line therapy for HER2-positive MBC patients, encompasses the combination of a taxane and the trastuzumab-pertuzumab doublet for 6-8 cycles, followed by a maintenance therapy with the trastuzumab-pertuzumab doublet until PD [4,10,11], de ning the optimal duration of therapy in this category of patients represents a challenge and emphasis is now growing with respect to the possibility of interrupting early the maintenance treatment in case of CR [12]. Interestingly, a recently published case series, described the cases of 4 patients with HER2-positive MBC that experienced a durable CR (ranging from 1 to 5 years) to rst line therapy and subsequently interrupted maintenance treatment, without no subsequent evidence of disease recurrence [13].…”

Section: Discussionmentioning

confidence: 99%

Clinico-pathological predictors of radiologic complete response to first-line anti-HER2 therapy in metastatic breast cancer: insights from real-world data of a nationwide cohort

Cucciniello,

Blondeaux,

Bighin

et al. 2024

Preprint

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Background: Up to 6-8% of patients with HER2 positive metastatic breast cancer (MBC) experience a radiologic complete response (rCR) to a first line of therapy, but these results mostly derive from dated and/or limited cohorts. Currently, there is limited data regarding which variables could predictive of a rCR to anti-HER2 therapies. Methods: Patients were selected from the database of the GIM14 study (NCT02284581) and classified according to the best radiologic response obtained to the first line anti-HER2 therapy and upon time-to-treatment-discontinuation (TTD). rCR was defined as complete response (CR) with a TTD > 3 months. The association across variables was tested through logistic regression and their prognostic impact in terms of overall survival (OS) was estimated using the Kaplan-Meier method and compared using the log-rank test. Results: Of the 3,423 patients included in the GIM14 study, 814 had HER2 positive MBC and data about best radiological response were available for 545 patients. Eighty patients (14.7%) experienced a rCR to first line anti-HER2 therapy with a TTD > 3 months. At multivariable analysis, HER2 Immunohistochemistry score 3+ (OR 2.03, p-value=0.01), presence of non visceral metastases (OR 1.51, p-value=0.01) and 1 metastatic site (OR 2.49, p-value= 0.01) were significantly associated with higher odds of obtaining a CR. Furthermore, amongst the 80 patients achieving a rCR, 56 (73%) experienced a durable and sustained CR with a TTD > 18 months. At multivariable analysis, only type of anti-HER2 therapy (OR 0.13 p-value<0.01 for trastuzumab-based therapy and OR 0.08, p-value=0.04 for other anti-HER2 therapy) was associated with a higher probability of achieving a CR with a TTD > 18 months. A median OS of 10.22 years was observed for patients that had achieved a CR to a first line anti-HER2 therapy and a TTD > 3 months. For patients with a CR and TTD > 18 months, a median OS of 12.73 years was observed. Conclusions: This study characterized a real-world cohort of HER2 positive MBC patients experiencing radiologic complete response to a first line treatment. Higher odds of achieving a complete response to a first-line anti-HER2 therapy with a TTD > 3 months were observed for HER2 Immunohistochemistry score 3+, presence of visceral metastases and presence of a single metastatic site. Additionally, a sustained complete response with a TTD > 18 months, was described in a subset of patients that had been exposed to a trastuzumab-based therapy.

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Patients who achieved long-term clinical complete response and subsequently terminated multidisciplinary and anti-HER2 therapy for metastatic breast cancer: A case series

Cited by 5 publications

References 34 publications

Three-year remission of metastatic breast cancer with treatment with ado-trastuzumab emtansine

Three-year remission of metastatic breast cancer with treatment with ado-trastuzumab emtansine

Termination of trastuzumab in HER2-positive metastatic breast cancer patients who received trastuzumab beyond progression

Clinico-pathological predictors of radiologic complete response to first-line anti-HER2 therapy in metastatic breast cancer: insights from real-world data of a nationwide cohort

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