Clinical outcomes of patients with breast cancer relapsing after (neo)adjuvant trastuzumab and receiving trastuzumab rechallenge or lapatinib-based therapy: a multicentre retrospective cohort study

ESMO Open

article

Eva Blondeaux¹  Arlindo R. Ferreira²  Francesca Poggio¹  Fabio Puglisi³  Claudia Bighin¹  Federico Sottotetti⁵  Filippo Montemurro⁶  Elena Poletto⁷  Antonella Lai⁸  Valentina Sini^1,10  Gabriele Minuti^1,11  Silvia Mura^1,12  Andrea Fontana^1,13  Piero Fregatti^1,14  Barbara Cardinali¹  Matteo Lambertini^1,15  Lucia Del Mastro¹ 

[1] U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino;Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation;Department of Medical Oncology;Department of Medicine, University of Udine;Unità Dipartimentale di Oncologia Medica;Day Hospital Oncologico Multidisciplinare, Istituto di Candiolo FPO-IRCCS;Department of Oncology, University of Udine;Oncologia Medica, Azienda Ospedaliera Universitaria di Sassari;Department of Oncology, Mater Olbia Hospital;U.O. Centro Oncologico S. Spirito-Nuovo Regina Margherita;Department of Oncology and Hematology;U.O.C. Medical Oncology, Ospedale Civile Santissima Annunziata;Polo Oncologico, Azienda Ospedaliero Universitaria Pisana;Department of Surgical Oncology, U.O. Chirurgia Senologica, IRCCS Ospedale Policlinico San Martino;Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino;Department of Internal Medicine and Medical Sciences ,(DiMI), School of Medicine, Università degli Studi di Genova

关键词: HER2-positive;    metastatic breast cancer;    lapatinib;    trastuzumab;    first-line therapy;   

DOI  :  10.1136/esmoopen-2020-000719

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background In the prepertuzumab era, we evaluated the clinical outcomes of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer who underwent first-line trastuzumab-based or lapatinib-based therapy according to prior exposure to (neo)adjuvant trastuzumab.Materials and methods In this multicentre retrospective cohort study conducted in 14 Italian centres of the Gruppo Italiano Mammella, consecutive patients undergoing first-line trastuzumab or lapatinib-based therapy were included. Analyses were performed according to the type of first-line therapy for metastatic disease (trastuzumab or lapatinib). Dichotomous clinical outcomes were analysed using logistic regression and time-to-event outcomes using Cox proportional hazard models controlling for relevant demographic, clinicopathological and therapy characteristics.Results Out of 450 patients included in the study, 416 (92%) received trastuzumab and 34 (7.5%) lapatinib. As compared with the trastuzumab cohort, more patients in the lapatinib cohort had a trastuzumab-free interval <1 month (37% vs 13.9%; p=0.017) and brain metastasis as first site of relapse (38.2% vs 9.4%; p<0.001). Among the 128 patients who relapsed after prior (neo)adjuvant trastuzumab, 101 (78.9%) received first-line trastuzumab and 27 (21.1%) first-line lapatinib. The following outcomes were observed with first-line lapatinib or trastuzumab, respectively: overall response rate 45.5% vs 61.3% (p=0.184), clinical benefit rate 68.2% vs 72.5% (p=0.691), median progression-free survival (PFS) 11.4 vs 12.0 months (p=0.814) and median overall survival (OS) 34.7 vs 48.2 months (p=0.722). In patients with brain metastasis as first site of relapse, median PFS was 12.2 vs 9.9 months (p=0.093) and median OS 33.7 vs 28.5 months (p=0.280), respectively.Conclusions In patients with HER2-positive breast cancer relapsing after prior (neo)adjuvant trastuzumab, first-line treatment with trastuzumab or lapatinib was not associated with a significant difference in the clinical outcomes. A non-significant trend favouring the use of lapatinib was observed in patients with brain metastasis as the first site of relapse.

【 授权许可】

CC BY|CC BY-NC-ND