Trastuzumab and survival of patients with metastatic breast cancer

Abstract

Introduction

Prognosis of Her2-positive breast cancer has changed since the introduction of trastuzumab for treatment in metastatic and early breast cancer. It was described to be even better compared to prognosis of Her2-negative metastatic breast cancer. The purpose of this study was to evaluate the effect of trastuzumab in our cohort. Besides the effect of adjuvant pretreatment with trastuzumab on survival of patients with metastatic Her2-positive breast cancer was analyzed.

Methods

All patients with primary breast cancer of the Regional Breast Cancer Center Dresden diagnosed during the years 2001–2013 were analyzed for treatment with or without trastuzumab in the adjuvant and in the metastatic treatment setting using Kaplan–Meier survival estimation and Cox regression. Age and tumor stage at time of first diagnosis of breast cancer as well as hormone receptor status, grading, time, and site of metastasis at first diagnosis of distant metastatic disease were analyzed.

Results

Of 4.481 female patients with primary breast cancer, 643 presented with metastatic disease. Her2-positive status was documented in 465 patients, including 116 patients with primary or secondary metastases. Median survival of patients with Her2-positive primary metastatic disease was 3.0 years (95% CI 2.3–4.0). After adjustment for other factors, survival was better in patients with Her2-positive breast cancer with trastuzumab therapy compared to Her2-negative metastatic disease (HR 2.10; 95% CI 1.58–2.79). Analysis of influence of adjuvant therapy with and without trastuzumab by Kaplan–Meier showed a trend for better survival in not pretreated patients. Median survival was highest in hormone receptor-positive Her2-positive (triple-positive) primary metastatic breast cancer patients with 3.3 years (95% CI 2.3–4.6).

Conclusion

Prognosis of patients with Her2-positive metastatic breast cancer after trastuzumab treatment is more favorable than for Her2-negative breast cancer. The role of adjuvant chemotherapy with or without trastuzumab warrants further research. Survival is best in triple-positive metastatic breast cancer. This will effect counseling at the time of first diagnosis of metastatic breast cancer.

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Acknowledgements

Tumorzentrum e.V. Dresden.

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Authors

Contributions

Author contributions

KK worked on the concept and design of the study and drafted the manuscript, also contributing to the acquisition, analysis, and interpretation of the data. PW participated in the conception of the work, acquisition and interpretation of data, critical revision of the manuscript for important intellectual content, final approval of the version to be published. OS performed the statistical analysis, final approval of publication. SK discussed and supervised statistical analysis and contributed to interpretation of data, critical revision of the manuscript for important intellectual content, final approval of publication. AF and GB contributed to the acquisition and interpretation of the histopathologic data, final approval of publication. All other authors: acquisition of data, critical revision of the manuscript for important intellectual content, final approval of publication. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Karin Kast.

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Ethics approval

For this analysis, we exclusively used secondary data. Ethics approval was therefore not necessary.

Informed consent

Informed consent for documentation in the registry and for further research was obtained from all individual patients included in the study.

Conflict of interest

Karin Kast declares to have received honoraries for presentations of Roche, Glaxo Smith Kline, Astra Zeneca, Pfizer, Sanofi Aventis, Novartis, TEVA. Pauline Wimberger declares to be a member of the advisory board of Roche. She also received honoraries for presentations of Roche, Glaxo Smith Kline, Astra Zeneca, Pfizer, Sanofi Aventis, Novartis, TEVA. All other authors declare that they have no competing interests.

Funding

No funding was available for this work. The authors declare that they have full control of all primary data and agree to allow the Journal to review their data if requested.

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Kast, K., Schoffer, O., Link, T. et al. Trastuzumab and survival of patients with metastatic breast cancer. Arch Gynecol Obstet 296, 303–312 (2017). https://doi.org/10.1007/s00404-017-4421-x

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Keywords

  • Trastuzumab
  • Survival
  • Metastatic breast cancer
  • Her2-positive