title: Do HER-2 positive metastatic breast cancer patients benefit from the use of trastuzumab beyond disease progression? A mono-institutional experience and systematic review of observational studies.
abstract: Though preclinical evidence supports the protracted use of trastuzumab to reach sustained anti-tumor activity, the activity of trastuzumab beyond disease progression remains controversial in HER-2 over-expressing (HER-2+) metastatic breast cancer (MBC) patients. We retrospectively evaluated a total of 59 patients with HER-2 + MBC treated at our institution with trastuzumab-based therapies. Our results were added to those obtained in similar observational studies and summary estimates for overall response (OR) and clinical benefit (CB) to first and second trastuzumab-based lines were calculated. In our series of patients we observed an OR of 59.3% and 27% for first and second trastuzumab-based lines, respectively, with a corresponding CB of 83% and 62.2%, respectively. Time to first and second progression were 9.5 months and 6.7 months, respectively. The combined analysis showed an OR of 50% for first trastuzumab-based regimen and 21.2% for second trastuzumab-based line. The corresponding values for CB were 77.6% and 42.6%, respectively. A second trastuzumab-containing regimen beyond progression yields a considerable rate of OR and CB in HER-2 + MBC patients. Randomized trials are warranted.
authors.affiliation: Division of Medical Oncology A, Regina Elena National Cancer Institute, Rome, Italy. alessandra.fabi@virgilio.it
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fabi
authors.forename: Giulio
authors.initials: G
authors.lastname: Metro
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Ferretti
authors.forename: Diana
authors.initials: D
authors.lastname: Giannarelli
authors.forename: Serena
authors.initials: S
authors.lastname: Di Cosimo
authors.forename: Paola
authors.initials: P
authors.lastname: Papaldo
authors.forename: Marcella
authors.initials: M
authors.lastname: Mottolese
authors.forename: Paolo
authors.initials: P
authors.lastname: Carlini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Felici
authors.forename: Michelangelo
authors.initials: M
authors.lastname: Russillo
authors.forename: Francesco
authors.initials: F
authors.lastname: Cognetti
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics / Q000378:metabolism* / Q000627:therapeutic use; D012189:Retrospective Studies; D000068878:Trastuzumab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab