title: Patterns of Care and Clinical Outcomes of First-Line Trastuzumab-Based Therapy in HER2-Positive Metastatic Breast Cancer Patients Relapsing After (Neo)Adjuvant Trastuzumab: An Italian Multicenter Retrospective Cohort Study.
abstract: BACKGROUND
  We evaluated the patterns of care and clinical outcomes of metastatic breast cancer patients treated with first-line trastuzumab-based therapy after previous (neo)adjuvant trastuzumab.
  
  
  METHODS
  A total of 416 consecutive, HER2-positive metastatic breast cancer patients who had received first-line trastuzumab-based therapy were identified at 14 Italian centers. A total of 113 patients had presented with de novo stage IV disease and were analyzed separately. Dichotomous clinical outcomes were analyzed using logistic regression and time-to-event outcomes using Cox proportional hazards models.
  
  
  RESULTS
  In the 202 trastuzumab-naïve patients and 101 patients with previous trastuzumab exposure, we observed the following outcomes, respectively: overall response rate, 69.9% versus 61.3% (adjusted odds ratio [OR], 0.62; p = .131), clinical benefit rate, 79.1% versus 72.5% (adjusted OR, 0.73; p = .370), median progression-free survival (PFS), 16.1 months versus 12.0 months (adjusted hazards ratio [HR], 1.33; p = .045), and median overall survival (OS), 52.2 months versus 48.2 months (adjusted HR, 1.18; p = .404). Patients with a trastuzumab-free interval (TFI) <6 months, visceral involvement, and hormone receptor-negative disease showed a worse OS compared with patients with a TFI of ≥6 months (29.5 vs. 48.3 months; p = .331), nonvisceral involvement (48.0 vs. 60.3 months; p = .270), and hormone receptor-positive disease (39.8 vs. 58.6 months; p = .003), respectively.
  
  
  CONCLUSIONS
  Despite the inferior median PFS, trastuzumab-based therapy was an effective first-line treatment for patients relapsing after (neo)adjuvant trastuzumab. Previous trastuzumab exposure and the respective TFI, type of first site of disease relapse, and hormone receptor status should be considered in the choice of the best first-line treatment option for HER2-positive metastatic breast cancer patients.
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy matteo.lambertini85@gmail.com.
authors.forename: Matteo
authors.initials: M
authors.lastname: Lambertini
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Arlindo R
authors.initials: AR
authors.lastname: Ferreira
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Poggio
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Puglisi
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bernardo
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Montemurro
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Poletto
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Emma
authors.initials: E
authors.lastname: Pozzi
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Rossi
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Risi
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Lai
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Zanardi
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Sini
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Ziliani
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Minuti
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Mura
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Grasso
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fontana
authors.affiliation: Department of Medical Oncology, U.O. Oncologia Medica 2, IRCCS AOU San Martino-IST, Genova, Italy; Department of Medical Oncology, Hospital de Santa Maria and Instituto de Medicina Molecular of the Faculty of Medicine of the University of Lisbon, Lisbon, Portugal; Department of Oncology, AOU S.M. Misericordia, University Hospital, Udine, Italy; Medical Oncology, IRCCS Fondazione Maugeri, Pavia, Italy; Investigative Clinical Oncology (INCO), Fondazione del Piemonte per L'Oncologia, Candiolo Cancer Center (IRCCS), Candiolo, Italy; Division of Medical Oncology, Ospedale Civile di Saluzzo, Saluzzo, Italy; Department of Radiology, Oncology and Human Pathology, Oncology Unit B, Sapienza University of Rome, Rome, Italy; Medical Oncology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS AOU San Martino-IST, Genova, Italy; Oncology Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy; Medical Oncology, Ospedale San Paolo, Savona, Italy; Department of Medical Oncology, Istituto Tumori Toscano, Civil Hospital of Livorno, Livorno, Italy; Medical Oncology, Ospedale Santissima Annunziata, Sassari, Italy; Medical Oncology, IRCCS San Matteo University Hospital Foundation, Pavia, Italy; U.O. Oncologia 2 Universitaria, Azienda Ospedaliero-Universitaria Pisana, Istituto Toscano Tumori, Pisa, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Del Mastro
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007558:Italy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000627:therapeutic use*; D012189:Retrospective Studies; D000068878:Trastuzumab / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab
keywords: HER2+; Metastatic breast cancer; Neoadjuvant/adjuvant trastuzumab; Retreatment; Trastuzumab-free interval