Takamichi Yokoe1, Sasagu Kurozumi2, Kazuki Nozawa3, Yukinori Ozaki4, Tetsuyo Maeda5, Shu Yazaki6, Mai Onishi7, Akihiro Fujimoto8, Sayuka Nakayama9, Yuko Tsuboguchi10, Tsutomu Iwasa11, Hitomi Sakai11, Misato Ogata12, Mitsuo Terada13, Meiko Nishimura14, Takuma Onoe14, Jun Masuda4, Michiko Kurikawa15, Hirotsugu Isaka16, Kanako Hagio17, Akihiko Shimomura18, Yuta Okumura19, Manabu Futamura20, Mototsugu Shimokawa21, Toshimi Takano22. 1. Department of Breast Surgery, National Cancer Center Hospital East, Kashiwa, Japan. 2. Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan. 3. Department of Clinical Oncology, Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan. 4. Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. 5. Department of Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan. 6. Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. 7. Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. 8. Breast Oncology Service, Saitama Medical University International Medical Center, Hidaka, Japan. 9. Advanced Cancer Translational Research Institute, Department of Surgery, Division of Breast Surgical Oncology, Showa University, Tokyo, Japan. 10. Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan. 11. Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-sayama, Japan. 12. Department of Medical Oncology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Kobe, Japan. 13. Department of Breast Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 14. Department of Medical Oncology, Hyogo Cancer Center, Akashi, Japan. 15. Department of Breast and Endocrine Surgery, Toranomon Hospital, Tokyo, Japan. 16. Department of Breast Surgery, School of Medicine, Kyorin University, Tokyo, Japan. 17. Department of Breast Surgery, Hokkaido University Hospital, Sapporo, Japan. 18. Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Tokyo, Japan. 19. Department of Internal Medicine, Kyushu University Beppu Hospital, Oita, Japan. 20. Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan. 21. Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan. 22. Department of Medical Oncology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan. takano@toranomon.gr.jp.
Abstract
BACKGROUND: Trastuzumab emtansine (T-DM1) treatment for human epidermal growth factor receptor-2 (HER2)-positive metastatic breast cancer after taxane with trastuzumab and pertuzumab is standard therapy. However, treatment strategies beyond T-DM1 are still in development with insufficient evidence of their effectiveness. Here, we aimed to evaluate real-world treatment choice and efficacy of treatments after T-DM1 for HER2-positive metastatic breast cancer. METHODS: In this multi-centre retrospective cohort study involving 17 hospitals, 325 female HER2-positive metastatic breast cancer patients whose post-T-DM1 treatment began between April 15, 2014 and December 31, 2018 were enrolled. The primary end point was the objective response rate (ORR) of post-T-DM1 treatments. Secondary end points included disease control rate (DCR), progression-free survival (PFS), time to treatment failure (TTF), and overall survival (OS). RESULTS: The median number of prior treatments of post-T-DM1 treatment was four. The types of post-T-DM1 treatments included (1) chemotherapy in combination with trastuzumab and pertuzumab (n = 102; 31.4%), (2) chemotherapy concomitant with trastuzumab (n = 78; 24.0%), (3), lapatinib with capecitabine (n = 63; 19.4%), and (4) others (n = 82; 25.2%). ORR was 22.8% [95% confidence interval (CI): 18.1-28.0], DCR = 66.6% (95% CI 60.8-72.0), median PFS = 6.1 months (95% CI 5.3-6.7), median TTF = 5.1 months (95% CI 4.4-5.6), and median OS = 23.7 months (95% CI 20.7-27.4). CONCLUSION: The benefits of treatments after T-DM1 are limited. Further investigation of new treatment strategies beyond T-DM1 is awaited for HER2-positive metastatic breast cancer patients.
BACKGROUND:Trastuzumabemtansine (T-DM1) treatment for humanepidermal growth factor receptor-2 (HER2)-positive metastatic breast cancer after taxane with trastuzumab and pertuzumab is standard therapy. However, treatment strategies beyond T-DM1 are still in development with insufficient evidence of their effectiveness. Here, we aimed to evaluate real-world treatment choice and efficacy of treatments after T-DM1 for HER2-positive metastatic breast cancer. METHODS: In this multi-centre retrospective cohort study involving 17 hospitals, 325 female HER2-positive metastatic breast cancerpatients whose post-T-DM1 treatment began between April 15, 2014 and December 31, 2018 were enrolled. The primary end point was the objective response rate (ORR) of post-T-DM1 treatments. Secondary end points included disease control rate (DCR), progression-free survival (PFS), time to treatment failure (TTF), and overall survival (OS). RESULTS: The median number of prior treatments of post-T-DM1 treatment was four. The types of post-T-DM1 treatments included (1) chemotherapy in combination with trastuzumab and pertuzumab (n = 102; 31.4%), (2) chemotherapy concomitant with trastuzumab (n = 78; 24.0%), (3), lapatinib with capecitabine (n = 63; 19.4%), and (4) others (n = 82; 25.2%). ORR was 22.8% [95% confidence interval (CI): 18.1-28.0], DCR = 66.6% (95% CI 60.8-72.0), median PFS = 6.1 months (95% CI 5.3-6.7), median TTF = 5.1 months (95% CI 4.4-5.6), and median OS = 23.7 months (95% CI 20.7-27.4). CONCLUSION: The benefits of treatments after T-DM1 are limited. Further investigation of new treatment strategies beyond T-DM1 is awaited for HER2-positive metastatic breast cancerpatients.
Entities:
Keywords:
Anti-HER2; Metastatic; Real world; Trastuzumab emtansine