Asian Pacific Journal of Cancer Prevention

Asian Pacific Journal of Cancer Prevention (아시아태평양암예방학회)
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Trastuzumab-based Retreatment after Lapatinib in Heavily Pretreated HER2 Positive Metastatic Breast Cancer: an Anatolian Society of Medical Oncology Study

  • Uncu, Dogan (Department of Medical Oncology, Education and Research Hospitals) ;
  • Bayoglu, Ibrahim Vedat (Department of Medical Oncology, Education and Research Hospitals) ;
  • Arslan, Ulku Yalcintas (Department of Medical Oncology, Education and Research Hospitals) ;
  • Kucukoner, Mehmet (Dicle University Faculty of Medicine) ;
  • Artac, Mehmet (Necmettin Erbakan University Faculty of Medicine) ;
  • Koca, Dogan (Department of Medical Oncology, Education and Research Hospitals) ;
  • Oguz, Arzu (Department of Medical Oncology, Education and Research Hospitals) ;
  • Demirci, Umut (Department of Medical Oncology, Education and Research Hospitals) ;
  • Arpaci, Erkan (Department of Medical Oncology, Education and Research Hospitals) ;
  • Dogan, Mutlu (Department of Medical Oncology, Education and Research Hospitals) ;
  • Kucukzeybek, Yuksel (Department of Medical Oncology, Education and Research Hospitals) ;
  • Turker, Ibrahim (Department of Medical Oncology, Education and Research Hospitals) ;
  • Isikdogan, Abdurrahman (Dicle University Faculty of Medicine) ;
  • Guler, Tunc (Necmettin Erbakan University Faculty of Medicine) ;
  • Zengin, Nurullah (Department of Medical Oncology, Education and Research Hospitals)
  • Published : 2015.05.18
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Abstract

Background: For HER2 positive metastatic breast cancer (MBC), continuing anti-HER2 therapy beyond progression is associated with improved outcome. However retreatment with trastuzumab after lapatinib progression is controversial. We retrospectively analyzed the efficacy of trastuzumab-based chemotherapy in HER2+ metastatic breast cancer patients whose disease progressed after lapatinib. Materials and Methods: Between October 2010 and May 2013, 54 patients whose disease progressed after lapatinib were retreated with trastuzumab-based chemotherapy. Efficacy and toxicity results were evaluated retrospectively. Results: The median age of patients was 46 (range 27-67). Fourteen patients (26%) had metastases at the time of diagnosis. All of the patients had received trastuzumab in an adjuvant or metastatic setting, while 16 (30%) had received two lines of trastuzumab. All patients had received lapatinib plus capecitabine. The median chemotherapy line for the metastatic setting was 2 (range 1-7). Cranial metastases were identified in 27 (50%) patients. 53 patients received trastuzumab-based chemotherapy following lapatinib progression while one patient received trastuzumab monotherapy. Combination chemotherapy consisted of navelbin (n=33), taxane (n=10), gemcitabine (n=2), platinum (n=2) and platinum with taxane (n=6). The median treatment cycle was 5 (range 1-44). Among 49 patients assessed for response 2 (4%) showed CR, 12 (25%) PR, 11 (22%) SD and 24 (49%) disease progression. Asymptomatic cardiotoxicity was reported in 2 (4%) of the patients. At a median follow-up of 9 months (1-39), median progression-free survival was 5 months (95% CI 4.1-5.9) and median overall survival was 10 months (95% CI 6.9-13.0). PFS and OS were not affected by the absence/presence of cranial metastases. Conclusions: Retreatment with trastuzumab-based therapy after lapatinib progression showed efficacy in heavily treated MBC patients.

Keywords

References

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