Abstract
Agents targeting the human epidermal growth factor receptor 2 (HER2) have improved outcomes of advanced HER2-positive breast cancer with durable responses. We evaluated first-line therapy long-term outcomes in patients responding for more than 1year. We retrospectively identified patients on first-line anti-HER2 therapy at The Royal Marsden Hospital for at least 1year from 2001 to 2016. Demographics, disease characteristics, treatments and adverse events were recorded. Simple statistics, Fisher's, Chi squared and log-rank tests were used. 208 patients on treatment for at least 1year had a median age of 54years (31-88). 38.0% had de novo metastatic disease and 55.9% were ER positive. Of the relapsed cases, 54.4% previously had trastuzumab. At the time of presentation of metastatic disease, 27.4% of the entire cohort had pulmonary, 43.7% liver and 10.6% brain involvement. 97.1% received trastuzumab and 1.44% lapatinib; 33.2% pertuzumab and trastuzumab. 82.7% received chemotherapy (usually taxanes). 47.6% received maintenance endocrine therapy. Median progression-free survival was 39.5months and overall survival 81.0months. Overall response rate was 87.5%. Cardiotoxicity occurred in 4.8% of cases. Seven patients stopped treatment electively after 17-87months and, so far, all remain in complete remission. First-line anti-HER2 treatment is associated with median overall survival longer than 6years in half of the patients free from disease progression after a year, but most still relapse eventually. Response prediction would be key to inform trial design and treatment decisions in this setting.
Published Version
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