曲妥珠单抗治疗 HER2 阳性晚期乳腺癌进展后：皇家马斯登医院的经验。
Trastuzumab beyond progression in HER2-positive advanced breast cancer: the Royal Marsden experience.
机构信息
Breast Unit Royal Marsden Hospital, Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK.
出版信息
Br J Cancer. 2011 May 24;104(11):1675-9. doi: 10.1038/bjc.2011.138. Epub 2011 Apr 26.
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.
背景
最近英国的临床指南建议，对于无脑转移的 HER-2 阳性（+ve）晚期乳腺癌患者，在疾病进展（PD）后不应继续使用曲妥珠单抗（T）。我们回顾性评估了在我们单位治疗的 HER-2+ve 局部晚期（LA）或转移性乳腺癌（MBC）患者，这些患者在 PD 后继续使用 T。
方法
我们从前瞻性维护的数据库中评估了所有 HER-2+ve LA 或 MBC 患者，这些患者在辅助治疗或一线 T 治疗进展后继续使用 T。从 PD 后继续使用 T 的时间点开始，我们计算了总疾病控制率、无进展生存期（TTP）和总生存期（OS）。
结果
确定了 114 名 HER-2+ve LA 或 MBC 患者在 PD 后继续使用 T 治疗。疾病的主要部位是内脏的有 84 例（74%）。在 PD 后继续使用 T 之前，有 76 例（66%）接受了一线化疗，有 21 例（19%）接受了二线或以上化疗。进展后，有 66 例（58%）接受了 T 联合化疗。在有记录的临床或影像学反应评估的 93 例（82%）患者中，有 67 例（59%）被认为患有稳定疾病或更好。中位 TTP 为 24 周（95%CI：21-28），中位 OS 为 19 个月（95%CI：12-24）。
结论
我们从一组未经选择的患者中获得的结果提供了额外的证据，表明在 PD 后继续使用 T 具有临床益处。
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