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Long-term outcome with targeted therapy in advanced/metastatic HER2-positive breast cancer: The Royal Marsden experience

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Abstract

Purpose

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 1 year.

Methods

We retrospectively identified patients on first-line anti-HER2 therapy at The Royal Marsden Hospital for at least 1 year 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.

Results

208 patients on treatment for at least 1 year had a median age of 54 years (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 39.5 months and overall survival 81.0 months. Overall response rate was 87.5%. Cardiotoxicity occurred in 4.8% of cases. Seven patients stopped treatment electively after 17–87 months and, so far, all remain in complete remission.

Conclusions

First-line anti-HER2 treatment is associated with median overall survival longer than 6 years 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.

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Acknowledgements

The authors wish to acknowledge the support of The Cridlan Trust and The Royal Marsden NIHR Biomedical Research Centre for Cancer.

Funding

No funding was required for this retrospective study.

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Authors and Affiliations

  1. Department of Medicine – Breast Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK

    Nicolò Matteo Luca Battisti & Alistair Ring

  2. Department of Medicine – Breast Unit, The Royal Marsden NHS Foundation Trust, 203 Fulham Rd, Chelsea, London, SW3 6JJ, UK

    Daniel Tong & Ian Smith

Authors
  1. Nicolò Matteo Luca Battisti
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  2. Daniel Tong
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  4. Ian Smith
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Corresponding author

Correspondence to Nicolò Matteo Luca Battisti.

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Conflict of interest

Dr Battisti has received travel grants from Genomic Health and speaker fees from Pfizer. Prof Smith attended an Advisory Board for Roche in 2014. Dr Ring has received advisory board fees from Roche, Novartis, Pfizer and Lilly and speaker fees from Novartis and Pfizer. Dr Tong has no conflict of interest.

Ethical approval

This research project has been reviewed and approved by The Committee for Clinical Review of The Royal Marsden NHS Foundation Trust. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent for systemic anticancer treatment was obtained from all individual participants included in this retrospective analysis.

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Battisti, N.M.L., Tong, D., Ring, A. et al. Long-term outcome with targeted therapy in advanced/metastatic HER2-positive breast cancer: The Royal Marsden experience. Breast Cancer Res Treat 178, 401–408 (2019). https://doi.org/10.1007/s10549-019-05406-6

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  • DOI: https://doi.org/10.1007/s10549-019-05406-6

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