Montemurro Filippo, Donadio Michela, Clavarezza Matteo, Redana Stefania, Jacomuzzi Maria Elena, Valabrega Giorgio, Danese Saverio, Vietti-Ramus Guido, Durando Antonio, Venturini Marco, Aglietta Massimo
Medical Oncology, Institute for Cancer Research and Treatment, Candiolo, Torino, Italy.
Oncologist. 2006 Apr;11(4):318-24. doi: 10.1634/theoncologist.11-4-318.
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.
我们试图描述接受基于曲妥珠单抗治疗的HER2阳性晚期乳腺癌患者的治疗模式和临床结局。1999年9月至2004年9月期间，184例连续的HER2阳性晚期乳腺癌患者接受了基于曲妥珠单抗的治疗。对患者进行随访直至死亡或2005年5月。对于接受基于曲妥珠单抗治疗后病情进展的患者，我们根据治疗情况计算了进展后首次治疗的缓解率（RR）、从首次使用曲妥珠单抗开始的总生存期（OS）、至第二次进展时间（TT-SP）以及进展后生存期（PPS）。在本次分析时，132例患者接受基于曲妥珠单抗的治疗后病情进展，89例患者死亡。在病情进展的患者中，21例经历快速进展，无法接受额外的抗癌治疗；40例患者继续使用曲妥珠单抗，单独使用（12例孤立性中枢神经系统进展患者）、联合化疗（23例患者）或联合内分泌治疗（5例患者）；71例患者停用曲妥珠单抗，并接受化疗（61例患者）或内分泌治疗（10例患者）作为进展后首次治疗。排除快速进展患者后，无论是否继续使用曲妥珠单抗，临床结局在RR（分别为18%和27%）、OS（分别为31个月和30个月）、TT-SP（分别为6个月和7个月）以及PPS（分别为21个月和19个月）方面相似。接受基于曲妥珠单抗治疗期间病情进展的HER2阳性晚期乳腺癌患者的临床结局可能不受继续使用曲妥珠单抗的影响。在此类患者中，最佳治疗策略需要在随机试验中进行评估。
