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. 2013 Aug;13(4):254-63.
doi: 10.1016/j.clbc.2013.02.010.

Clinicopathological features among patients with advanced human epidermal growth factor-2-positive breast cancer with prolonged clinical benefit to first-line trastuzumab-based therapy: a retrospective cohort study

Ines Vaz-Luis  1 , Davinia Seah, Erin M Olson, Nikhil Wagle, Otto Metzger-Filho, Jessica Sohl, Georgia Litsas, Harold J Burstein, Ian E Krop, Eric P Winer, Nancy U Lin
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Clinicopathological features among patients with advanced human epidermal growth factor-2-positive breast cancer with prolonged clinical benefit to first-line trastuzumab-based therapy: a retrospective cohort study

Ines Vaz-Luis et al. Clin Breast Cancer. 2013 Aug.

Abstract

Background: The magnitude of benefit of trastuzumab for the treatment of advanced HER2-positive breast cancer varies widely. In this retrospective study, we investigated the clinicopathological features associated with prolonged first-line trastuzumab-based treatment duration.

Patients and methods: A total of 164 patients diagnosed with advanced HER2-positive breast cancer and treated with first-line trastuzumab-based therapy from 1999 to 2009 were identified. Duration of treatment was classified according to tertiles. Different logistic regression models including age, disease-free interval, number of metastatic sites, visceral disease, hormone receptor, and adjuvant trastuzumab were fitted to investigate associations with benefit of prolonged trastuzumab-based therapies. The predictive value of each model was assessed using C-statistics.

Results: At a median follow-up of 5.8 years (range, 0.7-22.1 years), patients in the short-, intermediate-, and long-term treatment duration groups were given first-line trastuzumab-based therapy for < 7.2 months, 7.2 to 14 months, and > 14 months, respectively. In the multivariate analysis, patients with long-term clinical benefit had a higher likelihood of having hormone receptor-positive tumors (odds ratio [OR]positive vs. negative = 2.39 [95% confidence interval (CI), 1.08-5.31]; P = .032); and a lower likelihood of having received adjuvant trastuzumab (ORadjuvant trastuzumab vs. no adjuvant trastuzumab = 0.30 [95% CI, 0.10-0.96]; P = .043]. C-statistics varied between 0.634 and 0.699.

Conclusion: Long-term benefit of trastuzumab-based therapy is associated with hormone receptor positivity and the absence of previous adjuvant trastuzumab. Nevertheless, clinicopathological features had a low predictive value for prolonged treatment duration. The validation of the current findings and the identification of molecular features associated the magnitude of trastuzumab benefit should be encouraged.

Keywords: HER2-positive; Outcomes; Treatment Duration.

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Figures

Figure 1
Figure 1
Patient Cohort Abbreviations: EMR = electronic medical record; FISH = fluorescence in situ hybridization; FU = follow-up; IHC = immunohistochemistry.
Figure 2
Figure 2
Duration of First-Line Trastuzumab-Based Treatment for Stage I to III Patients (Short-Term and Long-Term Treatment Duration Groups) (A) Overall Time to Treatment Change. (B) Time to Treatment Change According to Hormone Receptor Status. (C) Time to Treatment Change According to Adjuvant Therapy Abbreviation: HR = hormone receptor.
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