title: Trastuzumab beyond progression in HER2-positive advanced breast cancer: the Royal Marsden experience.
abstract: BACKGROUND
  Recent UK clinical guidance advises against continuing trastuzumab (T) beyond disease progression (PD) in the absence of brain metastases in patients with HER-2 positive (+ve) advanced breast cancer .We have retrospectively evaluated the outcome of patients with HER-2+ve locally advanced (LA) or metastatic breast cancer (MBC) who continued T beyond PD, treated in our unit.
  
  
  METHODS
  All HER-2+ve patients on our prospectively maintained database with LA or MBC who received T beyond PD after adjuvant or one line of T for advanced disease were assessed for response and outcome. From the timepoint of T continuation beyond PD, we calculated the overall disease control rate, time to progression (TTP), and overall survival (OS).
  
  
  RESULTS
  One hundred and fourteen patients with HER-2+ve LA or MBC treated with T beyond PD were identified. The main site of disease was visceral in 84 (74%) patients. Seventy-six (66%) had one line of chemotherapy before continuation of T beyond PD and 21 (19%) had two or more. Post-progression, 66 (58%) received T combined with chemotherapy. Of the 93 (82%) patients with documented clinical or radiological response evaluation, 67 (59%) were considered as having stable disease or better. The median TTP was 24 weeks (95% CI: 21-28) and the median OS was 19 months (95% CI: 12-24).
  
  
  CONCLUSIONS
  Our results from an unselected group of patients provide additional evidence that continuation of T beyond PD is of clinical benefit.
authors.affiliation: Breast Unit Royal Marsden Hospital, Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK.
authors.forename: T
authors.initials: T
authors.lastname: Waddell
authors.forename: A
authors.initials: A
authors.lastname: Kotsori
authors.forename: A
authors.initials: A
authors.lastname: Constantinidou
authors.forename: N
authors.initials: N
authors.lastname: Yousaf
authors.forename: S
authors.initials: S
authors.lastname: Ashley
authors.forename: M
authors.initials: M
authors.lastname: Parton
authors.forename: M
authors.initials: M
authors.lastname: Allen
authors.forename: N
authors.initials: N
authors.lastname: Starling
authors.forename: P
authors.initials: P
authors.lastname: Papadopoulos
authors.forename: M
authors.initials: M
authors.lastname: O'Brien
authors.forename: I
authors.initials: I
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Johnston
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001932:Brain Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000235:genetics; D018450:Disease Progression; D005260:Female; D018734:Genes, erbB-2; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D000068878:Trastuzumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068878:Trastuzumab