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The Oncologist, Vol. 11, No. 4, 318-324, April 2006; doi:10.1634/theoncologist.11-4-318
© 2006 AlphaMed Press

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Breast Cancer

Outcome of Patients with HER2-Positive Advanced Breast Cancer Progressing During Trastuzumab-Based Therapy

Filippo Montemurroa, Michela Donadiob, Matteo Clavarezzac, Stefania Redanaa, Maria Elena Jacomuzzid, Giorgio Valabregaa, Saverio Danesee, Guido Vietti-Ramusf, Antonio Durandog, Marco Venturinic, Massimo Agliettaa

a Medical Oncology, Institute for Cancer Research and Treatment, Candiolo, Torino, Italy; b Centro Oncologico Subalpino (COES), Molinette Hospital, Torino, Italy; c Senology Disease Management Team, Istituto Nazionale Tumori, Genova, Italy; d Gynaecologic Oncology, Mauriziano Hospital, Torino, Italy; e Gynaecology, S. Anna Hospital, Torino, Italy; f Internal Medicine, Giovanni Bosco Hospital, Torino, Italy; g Clinica Universitaria, S. Anna Hospital, Torino, Italy

Key Words. HER2 • Metastatic breast cancer • Survival • Time to progression • Trastuzumab • Tumor progression

Correspondence: Filippo Montemurro, M.D., Medical Oncology, Institute for Cancer Research and Treatment, IRCC Candiolo, Strada Provinciale 142, 10060 Candiolo, Torino, Italy. Telephone: 39-011-9933250; Fax: 39-011-9933275; e-mail: fmontemurro{at}ircc.mauriziano.it

We sought to describe patterns of treatment and clinical outcome in patients with HER2-positive advanced breast cancer progressing on trastuzumab-based therapy. One hundred eighty-four consecutive HER2-positive advanced breast cancer patients received trastuzumab-based therapy between September 1999 and September 2004. Patients were followed up until death or May 2005. For patients progressing on trastuzumab-based therapy, we calculated the response rate (RR) to the first post-progression treatment, overall survival (OS) from the first administration of trastuzumab, time to second progression (TT-SP), and post-progression survival (PPS), according to treatment. At the time of this analysis, 132 patients had progressed on trastuzumab-based therapy, and 89 had died. Of the progressing patients, 21 experienced rapid progression and could not receive additional anticancer treatments;40 patients continued trastuzumab either alone (12 patients with isolated central nervous system progression), with chemotherapy (23 patients), or with endocrine therapy (5 patients); and 71 stopped trastuzumab and received chemotherapy (61 patients) or endocrine therapy (10 patients) as the first post-progression treatment. Excluding patients with rapid progression, clinical outcomes were similar whether trastuzumab was continued or not, in terms of RR (18% and 27%, respectively), OS (31 and 30 months, respectively), TT-SP (6 and 7 months, respectively), and PPS (21 and 19 months, respectively). The clinical outcome of patients with HER2-positive advanced breast cancer progressing during trastuzumab-based therapy might not be influenced by continuing trastuzumab. The optimal therapeutic strategy in this setting of patients needs evaluation in randomized trials.




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