Clinical outcome in women with HER2-positive de novo or recurring stage IV breast cancer receiving trastuzumab-based therapy |
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| Institution: | 1. Unit of Investigative Clinical Oncology (INCO), Fondazione del Piemonte per l''Oncologia, Institute for Cancer Research and Treatment (IRCCs), Candiolo, Italy;2. Division of Medical Oncology, European Institute of Oncology, Milan, Italy;3. Division of Medical Oncology, Fondazione del Piemonte per l''Oncologia, Institute for Cancer Research and Treatment (IRCCs), Candiolo, Italy;4. University of Turin, Department of Biomedical Sciences and Human Oncology, Turin, Italy;5. Department of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan, Milan, Italy;1. Department of Surgery, Yale-New Haven Hospital, New Haven, CT 06520, USA;2. Department of Surgery, Morristown Medical Center, Morristown, NJ 07960, USA;3. Division of Biostatistics, Yale School of Public Health, New Haven, CT 06520, USA;4. Section of Surgical Oncology, Yale School of Medicine, New Haven, CT 06520, USA;5. Section of Thoracic Surgery, Yale School of Medicine, New Haven, CT 06520, USA;1. Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands;2. Department of Surgical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands;4. Department of Pulmonology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands;3. Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands;1. Value Evidence & Outcomes, GSK, Brentford, Middlesex, UK;2. ICON Health Economics, ICON, NY, USA;3. ICON Health Economics, ICON, Toronto, Canada;4. Respiratory Medical Franchise, GSK, Brentford, Middlesex, UK;5. Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK;6. Value Evidence & Outcomes, GSK, Research Triangle Park, NC, USA;7. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada;1. Medical Oncology Unit, Department of Human Pathology “G. Barresi”, University of Messina, Messina, Italy;2. Cancer Biology and Precision Medicine Program, Hospital Germans Trias i Pujol, Catalan Institute of Oncology, Badalona, Spain;3. Hospital Universitario Ramón y Cajal, Madrid, Spain;4. Hospital San Carlos, Madrid, Spain;5. Hospital Clínico Universitario, Valencia, Spain;6. Hospital Universitario Puerta de Hierro-Majadahonda (IDIPHIM), Madrid, Spain;7. Hospital Clinico Lozano Blesa, Zaragoza, Spain;8. Hospital General, Facultad Medicina, Valencia, Spain;9. Consorcio Hospitalario de Terrassa, Terrassa, Spain;10. Medical Oncology Department, Catalan Institute of Oncology, Hospital Germans Trias i Pujol, Badalona, Spain;11. Dr Rosell Oncology Institute, Quirón Dexeus University Hospital, Barcelona, Spain;12. Germans Trias i Pujol Health Sciences Institute and Hospital, Campus Can Ruti, Badalona, Spain |
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| Abstract: | BackgroundFive to 10% of women with newly diagnosed breast cancer have synchronous metastases (de novo stage IV). A further 20% will develop metastases during follow-up (recurring stage IV). We compared the clinical outcomes of women with HER2-positive metastatic breast cancer (MBC) receiving first-line trastuzumab-based therapy according to type of metastatic presentation.Patients and methodsRetrospective analysis of 331 MBC patients receiving first-line trastuzumab-based treatment. Response rates (RR) were compared by the chi-square test. Time-to progression (TTP) and overall survival (OS) curves were compared by the log-rank test. Cox-proportional hazards models were used to study predictors of PFS and OS, including the type of metastatic presentation.ResultsSeventy-seven patients (23%) had de novo stage IV disease. Forty-six of these patients underwent surgery of the primary (“de novo/surgery”). Response rates to first-line trastuzumab-based therapy and median progression-free survival did not differ in patients with “recurring”, “de novo/surgery” and “de novo” without surgery (“de novo/no surgery) stage IV breast cancer. However, women with “de novo/surgery” stage IV breast cancer had the longest median OS (60 months), and those with “de novo/no surgery” stage IV breast cancer the shortest (26 months). For women with recurring metastatic breast cancer median OS was 40 months (overall log-rank test, p < 0.01). Multivariate analysis confirmed these findings.ConclusionOur analysis shows that response rates and PFS to first-line trastuzumab-based therapy do not differ significantly between de novo and recurring stage IV, HER2 positive breast cancer. The observed difference in OS favoring women with de novo stage IV disease submitted to surgery of the primary tumor could be the result of a selection bias. |
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| Keywords: | Breast cancer HER2 Trastuzumab Recurring Metastases |
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