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Trastuzumab beyond progression in HER2-positive advanced breast cancer: the Royal Marsden experience.

Waddell T, Kotsori A, Constantinidou A, Yousaf N, Ashley S, Parton M, Allen M, Starling N, Papadopoulos P, O'Brien M, Smith I, Johnston S - Br. J. Cancer (2011)

Bottom Line: 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).Our results from an unselected group of patients provide additional evidence that continuation of T beyond PD is of clinical benefit.

View Article: PubMed Central - PubMed

Affiliation: Breast Unit Royal Marsden Hospital, Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK.

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).

Conclusion: Our results from an unselected group of patients provide additional evidence that continuation of T beyond PD is of clinical benefit.

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Related in: MedlinePlus

Identification of eligible patients.
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Related In: Results  -  Collection


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fig1: Identification of eligible patients.

Mentions: Through our initial database screening, 128 patients were identified who appeared eligible for inclusion in the study. However, 14 of these patients were subsequently excluded from the data collection (see Figure 1) leaving a total of 114 patients. At the time of analysis, 35 patients (31%) were still alive with a median follow-up of 20 months. The main site of disease was visceral in 84 patients (74%), including 37 patients (32%) with central nervous system involvement. Twenty-six patients (23%) developed brain metastases while on first-line trastuzumab and continued trastuzumab beyond progression in the brain. Thirty patients (26%) had soft tissue and/or bone metastases only. Fifty-nine patients (52%) had received adjuvant chemotherapy, whereas only 13 (11%) had received adjuvant trastuzumab. Other baseline information and previous and subsequent lines of therapy are outlined in Table 1.


Trastuzumab beyond progression in HER2-positive advanced breast cancer: the Royal Marsden experience.

Waddell T, Kotsori A, Constantinidou A, Yousaf N, Ashley S, Parton M, Allen M, Starling N, Papadopoulos P, O'Brien M, Smith I, Johnston S - Br. J. Cancer (2011)

Identification of eligible patients.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3111155&req=5

fig1: Identification of eligible patients.
Mentions: Through our initial database screening, 128 patients were identified who appeared eligible for inclusion in the study. However, 14 of these patients were subsequently excluded from the data collection (see Figure 1) leaving a total of 114 patients. At the time of analysis, 35 patients (31%) were still alive with a median follow-up of 20 months. The main site of disease was visceral in 84 patients (74%), including 37 patients (32%) with central nervous system involvement. Twenty-six patients (23%) developed brain metastases while on first-line trastuzumab and continued trastuzumab beyond progression in the brain. Thirty patients (26%) had soft tissue and/or bone metastases only. Fifty-nine patients (52%) had received adjuvant chemotherapy, whereas only 13 (11%) had received adjuvant trastuzumab. Other baseline information and previous and subsequent lines of therapy are outlined in Table 1.

Bottom Line: 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).Our results from an unselected group of patients provide additional evidence that continuation of T beyond PD is of clinical benefit.

View Article: PubMed Central - PubMed

Affiliation: Breast Unit Royal Marsden Hospital, Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK.

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).

Conclusion: Our results from an unselected group of patients provide additional evidence that continuation of T beyond PD is of clinical benefit.

Show MeSH
Related in: MedlinePlus