title: Trastuzumab re-treatment following adjuvant trastuzumab and the importance of distant disease-free interval: the HERA trial experience.
abstract: This retrospective analysis conducted using data from patients enrolled onto the Herceptin Adjuvant has two objectives: The first is to evaluate the impact of the time interval between the end of adjuvant trastuzumab and distant recurrence (TDRI) upon overall survival (OS). The second is to describe the duration of trastuzumab-based regimens in the metastatic setting for patients previously treated with adjuvant trastuzumab. The first objective included 187 patients treated with adjuvant trastuzumab and diagnosed with distant recurrence at 4-year median follow-up. The second objective included data from questionnaires sent to investigators retreating patients with trastuzumab upon distant recurrence: 144 of 156 questionnaires were returned (93 %), and 90 patients were selected based on available clinical information and consent for subsequent studies. There was no statistically significant relationship between TDRI following 1 year of adjuvant trastuzumab and OS from distant recurrence: hazard ratio 0.991, p = 0.46. The median OS from distant recurrence was numerically longer among patients with a TDRI of ≥12 months (n = 103) than <12 months (n = 84) but not statistically significant (23.7 vs. 17.8 months, p = 0.47). The median duration of first-line trastuzumab-based regimens for patients previously treated with adjuvant trastuzumab and diagnosed with distant disease recurrence was 8.8 months (n = 88). This retrospective, exploratory study suggests that TDRI did not impact on OS measured from distant recurrence. We argue that prospective collection of treatment information beyond disease progression should be included in future clinical studies.
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue Yawkey, Boston, 1238, USA. otto_metzger@dfci.harvard.edu.
authors.forename: Otto
authors.initials: O
authors.lastname: Metzger-Filho
authors.affiliation: Department of Medical Oncology and Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium. evandro.azambuja@bordet.be.
authors.forename: Evandro
authors.initials: E
authors.lastname: de Azambuja
authors.affiliation: Frontier Science (Scotland) Ltd, Kincraig, Kingussie, UK. marion.procter@frontier-science.co.uk.
authors.forename: Marion
authors.initials: M
authors.lastname: Procter
authors.affiliation: Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium. magalie.krieguer@bordet.be.
authors.forename: Magalie
authors.initials: M
authors.lastname: Krieguer
authors.affiliation: Breast Unit, Royal Marsden Hospital, and Institute of Cancer Research, London, UK. ian.smith@rmh.nhs.uk.
authors.forename: Ian
authors.initials: I
authors.lastname: Smith
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY, USA. baselgaj@mskcc.org.
authors.forename: Jose
authors.initials: J
authors.lastname: Baselga
authors.affiliation: Edinburgh Cancer Research Centre, Western general Hospital, University of Edinburgh, Crewe Road South, Edinburgh, UK. d.cameron@ed.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: Cameron
authors.affiliation: Department of Gynecology and Obstetrics and Multidisciplinary Breast Cancer Center, Helios Klinikum, Berlin-Buch, Germany. michael.untch@helios-kliniken.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Untch
authors.affiliation: Department of Gynecology and Obstetrics, Klinikum Off enbach, Off Enbach, Germany. christian.jackish@klinikum-offenbach.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Jackisch
authors.affiliation: Department of Medical Oncology, The Andrew Love Cancer Centre, Deakin University, Geelong, Australia. richard@barwonhealth.org.au.
authors.forename: Richard
authors.initials: R
authors.lastname: Bell
authors.affiliation: Department of Medical Oncology, San Raffaele Institute, Milan, Italy. l.gianni@hsr.it.
authors.forename: Luca
authors.initials: L
authors.lastname: Gianni
authors.affiliation: European Institute of Oncology, Milan, Italy. aron.goldhirsch@ibcsg.org.|Swiss Center for Breast Health, Sant'Anna Clinic, Lugano-Sorengo, Switzerland. aron.goldhirsch@ibcsg.org.
authors.forename: Aron
authors.initials: A
authors.lastname: Goldhirsch
authors.affiliation: Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium. martine.piccart@bordet.be.
authors.forename: Martine
authors.initials: M
authors.lastname: Piccart
authors.affiliation: Department of Biostatistics and Computational Biology, International Breast Cancer Study Group (IBCSG) Statistical Center, Dana-Farber Cancer Institute, Harvard School of Public Health, Harvard Medical School, Boston, USA. gelber@jimmy.harvard.edu.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Gelber
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D019233:Retreatment; D000068878:Trastuzumab / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D000068878:Trastuzumab
keywords: Breast cancer; Disease-free survival; HER2+