title: Human epidermal growth factor receptor 2-positive breast cancer relapsing post-adjuvant trastuzumab: pattern of recurrence, treatment and outcome.
abstract: BACKGROUND
  The purpose of this study is to evaluate the response to and benefit of first-line metastatic treatment (including re-exposure to trastuzumab) for patients relapsing after exposure to adjuvant trastuzumab (AT).
  
  
  METHODS
  All HER2-positive breast cancer cases relapsing after exposure to AT at our institutions were identified. Clinico-pathologic details, pattern of relapse, and treatment in the metastatic setting were documented. Response to treatment and outcome were assessed.
  
  
  RESULTS
  Twenty-nine relapses were recorded. The median time to relapse was 18.4 months from diagnosis, and 8.7 months from AT initiation. At a median time of observation of 9.9 months, 18 patients had progressed on first-line therapy. The median time-to-progression (TTP) was 8.6 months. Fifteen patients received trastuzumab as first-line treatment, with no statistical difference in TTP between this group and those not re-exposed to trastuzumab. TTP was not statistically different between those relapsing on or after AT. Overall survival was longer for those who relapsed after completion of 1 year of AT as well as those who received further trastuzumab at relapse; however, this did not reach statistical significance.
  
  
  CONCLUSIONS
  Overall survival was longer in patients who relapse after completion of AT and who received further trastuzumab at progression.
authors.affiliation: Department of Medical Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Krell
authors.forename: Colin R
authors.initials: CR
authors.lastname: James
authors.forename: Deep
authors.initials: D
authors.lastname: Shah
authors.forename: Ondrej
authors.initials: O
authors.lastname: Gojis
authors.forename: Adrian
authors.initials: A
authors.lastname: Lim
authors.forename: Pippa
authors.initials: P
authors.lastname: Riddle
authors.forename: Riz
authors.initials: R
authors.lastname: Ahmad
authors.forename: Andreas
authors.initials: A
authors.lastname: Makris
authors.forename: Andrew
authors.initials: A
authors.lastname: Cowdray
authors.forename: Angela
authors.initials: A
authors.lastname: Chow
authors.forename: Tamerlan
authors.initials: T
authors.lastname: Babayev
authors.forename: Peter
authors.initials: P
authors.lastname: Madden
authors.forename: Robert
authors.initials: R
authors.lastname: Leonard
authors.forename: Susan
authors.initials: S
authors.lastname: Cleator
authors.forename: Carlo
authors.initials: C
authors.lastname: Palmieri
mesh_terms: D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis*; 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; C508053:ERBB2 protein, human