Abstract
Lapatinib is widely used in the later lines treatment of HER2 positive metastatic breast cancer (MBC). EGF104900 study suggested that among patients who experienced progression on prior trastuzumab‐containing regimens, lapatinib plus trastuzumab had better effects than trastuzumab alone. However, no evidence was discovered in terms of lapatinib plus capetabine compared with lapatinib plus trastuzumab plus chemotherapy, as well as a treatment after progression on lapatinib. We evaluated the medical records retrospectively of all MBC patients with HER2 positive disease who progressed on prior trastuzumab‐containing regimens (advanced setting) and a taxane (any setting) and received lapatinib‐based treatment from 2015 to 2018 in five institutions in China. A total of 242 patients were available for analysis. Among them, 164 (68%) patients received lapatinib plus capetabine (LX) and 78 (32%) patients received lapatinib plus trastuzumab and one chemotherapy (HLC). The median progression‐free survival (PFS) of the HLC group was significantly superior to the LX group (8.8 months vs 5.0 months, P < .0000001). No significant difference in grade 3 or worse adverse events was observed in two groups (P = .57). A total of 175 patients were available for the analysis of the postlapatinib treatment. Continuation of lapatinib showed superior mPFS results compared to the non‐anti‐HER2 treatment (4 months vs 2 months, P = .01) and similar results compared to switch to other anti‐HER2 treatments (4 months vs 4 months, P = .88). In patients who had progressed on prior trastuzumab‐base therapy, HLC provided a new dual‐targeting treatment option for the later lines therapy of patients with HER2 positive MBC. Moreover, evidence of cross‐line use of lapatinib was provided.
Highlights
Breast cancer (BC) is still the most common malignant tumor and a major cause of death among women worldwide, causing nearly 2.1 million new cases and 626 thousand deaths in 2018, mostly for metastatic breast cancer (MBC).[1]
In a randomized phase III EGF100151 trial, human epidermal growth factor receptor-2 (HER2)-positive MBC patients pretreated with trastuzumab-based therapy were enrolled and the results showed that the time to progression (TTP) in lapatinib plus capecitabine (LX) group was significantly better than the capecitabine monotherapy group (95% confidence interval [CI], 0.43-0.77; P < .01).[4]
Our study revealed the real-world practice of lapatinib in combination with capecitabine or trastuzumab plus one chemotherapy and investigated the treatment after the lapatinib-based regimen
Summary
Breast cancer (BC) is still the most common malignant tumor and a major cause of death among women worldwide, causing nearly 2.1 million new cases and 626 thousand deaths in 2018, mostly for metastatic breast cancer (MBC).[1]. In a randomized phase III EGF100151 trial, HER2-positive MBC patients pretreated with trastuzumab-based therapy were enrolled and the results showed that the time to progression (TTP) in lapatinib plus capecitabine (LX) group was significantly better than the capecitabine monotherapy group (95% confidence interval [CI], 0.43-0.77; P < .01).[4] This research proved the efficacy of LX among pretreated HER2 + MBC. Several studies indicated that the continuation of trastuzumab after progression on it had better efficacy compared with discontinuation and the reason might lie in the antibody-dependent cell-mediated cytotoxicity (ADCC) effect of trastuzumab.[8,9] lapatinib had a different mechanism without ADCC. This study aims to figure out the efficacy and safety of LX and HLC among patients previously treated with trastuzumab and taxane and the treatment pattern after the progression of lapatinib in clinical practice
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