Radiological complete remission in HER2-positive metastatic breast cancer patients: what to do with trastuzumab?

Steenbruggen, Tessa G; Bouwer, Nathalie I; Smorenburg, Carolien H.; Rier, Hánah N.; Jager, Agnes; Beelen, Karin; Tije, Albert J. ten; Jong, P.C. de; Drooger, Jan C.; Holterhues, Cynthia; Kitzen, Jos; Levin, Mark‐David; Sonke, Gabe S.

doi:10.1007/s10549-019-05427-1

Cited by 15 publications

(13 citation statements)

References 34 publications

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“…We included patients with HER2-positive MBC who received > 1 cycle of trastuzumab-based treatment in one of eight participating Dutch hospitals between January 2000 and December 2014, as described before [12]. Patients were identified using the Netherlands Cancer Registry.…”

Section: Patients and Data Collectionmentioning

confidence: 99%

Cardiotoxicity during long-term trastuzumab use in patients with HER2-positive metastatic breast cancer: who needs cardiac monitoring?

Bouwer

Steenbruggen

Rosmalen

et al. 2021

Breast Cancer Res Treat

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Purpose Patients with HER2-positive metastatic breast cancer (MBC) usually receive many years of trastuzumab treatment. It is unknown whether these patients require continuous left ventricular ejection fraction (LVEF) monitoring. We studied a real-world cohort to identify risk factors for cardiotoxicity to select patients in whom LVEF monitoring could be omitted. Methods We included patients with HER2-positive MBC who received > 1 cycle of trastuzumab-based therapy in eight Dutch hospitals between 2000 and 2014. Cardiotoxicity was defined as LVEF < 50% that declined > 10%-points and was categorized into non-severe cardiotoxicity (LVEF 40–50%) and severe cardiotoxicity (LVEF < 40%). Multivariable Cox and mixed model analyses were performed to identify risk factors associated with cardiotoxicity. Additionally, we explored the reversibility of cardiotoxicity in patients who continued trastuzumab. Results In total, 429 patients were included. Median follow-up for cardiotoxicity was 15 months (interquartile range 8–31 months). The yearly incidence of non-severe + severe cardiotoxicity in the first and second year was 11.7% and 9.1%, respectively, which decreased thereafter. The yearly incidence of severe cardiotoxicity was low (2.8%) and stable over time. In non-smoking patients with baseline LVEF > 60% and no cardiotoxicity during prior neoadjuvant/adjuvant treatment, the cumulative incidence of severe cardiotoxicity was 3.1% after 4 years of trastuzumab. Despite continuing trastuzumab, LVEF decline was reversible in 56% of patients with non-severe cardiotoxicity and in 33% with severe cardiotoxicity. Conclusions Serial cardiac monitoring can be safely omitted in non-smoking patients with baseline LVEF > 60% and without cardiotoxicity during prior neoadjuvant/adjuvant treatment.

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Section: Patients and Data Collectionmentioning

confidence: 99%

Cardiotoxicity during long-term trastuzumab use in patients with HER2-positive metastatic breast cancer: who needs cardiac monitoring?

Bouwer

Steenbruggen

Rosmalen

et al. 2021

Breast Cancer Res Treat

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“…47 For HER2positive MBC with minimal disease burden and an extended period of stability, we consider holding therapy with surveillance for progression every 3-6 months. 65,66 To decrease frequent visits for those receiving H 6 P, we offer extending the dosing interval from 3 weeks to 4 weeks, especially if receiving other treatments every 4 weeks. 67 We advise caution in the use of therapies with high risk of pulmonary toxicity, such as immunotherapy for metastatic TNBC 68 or trastuzumab deruxtecan for HER2-positive MBC.…”

Section: Metastatic Breast Cancermentioning

confidence: 99%

Management of Breast Cancer During the COVID-19 Pandemic: A Stage- and Subtype-Specific Approach

Sheng

Santa-Maria

Mangini

et al. 2020

JCO Oncology Practice

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The COVID-19 pandemic has rapidly changed delivery of cancer care. Many nonurgent surgeries are delayed to preserve hospital resources, and patient visits to health care settings are limited to reduce exposure to SARS-CoV-2. Providers must carefully weigh risks and benefits of delivering immunosuppressive therapy during the pandemic. For breast cancer, a key difference is increased use of neoadjuvant systemic therapy due to deferral of many breast surgeries during the pandemic. In some cases, this necessitates increased use of genomic tumor profiling on core biopsy specimens to guide neoadjuvant therapy decisions. Breast cancer treatment during the pandemic requires multidisciplinary input and varies according to stage, tumor biology, comorbidities, age, patient preferences, and available hospital resources. We present here the Johns Hopkins Women’s Malignancies Program approach to breast cancer management during the COVID-19 pandemic. We include algorithms based on tumor biology and extent of disease that guide management decisions during the pandemic. These algorithms emphasize medical oncology treatment decisions and demonstrate how we have operationalized the general treatment recommendations during the pandemic proposed by national groups, such as the COVID-19 Pandemic Breast Cancer Consortium. Our recommendations can be adapted by other institutions and medical oncology practices in accordance with local conditions and resources. Guidelines such as these will be important as we continue to balance treatment of breast cancer against risk of SARS-CoV-2 exposure and infection until approval of a vaccine.

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“…The final CLEOPATRA results after 8 years of follow‐up show a sustained response to first‐line treatment with taxane, trastuzumab, and pertuzumab, with a median OS of 37% for the combined taxane, trastuzumab, and pertuzumab group compared with 23% in the combined taxane, trastuzumab, and placebo group, with a similar long‐term toxicity profile 24 . Given these results, the question of when to discontinue HER2‐directed therapy in the setting of a sustained radiologic complete response to therapy is a pertinent question 71 ; further research is needed to identify patients in whom trastuzumab may safely be discontinued. T‐DM1 was FDA approved on the basis of the EMILIA trial and is typically administered in the second‐line metastatic setting 23 .…”

Section: Therapeutic Advances and Challenges In The Treatment Of Advamentioning

confidence: 99%

Evolving standards of care and new challenges in the management of HER2‐positive breast cancer

Choong

Cullen

O’Sullivan

2020

CA A Cancer J Clinicians

101

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The management of human epidermal growth factor receptor (HER2)positive breast cancer (BC) has rapidly evolved over the last 20 years. Major advances have led to US Food and Drug Administration approval of 7 HER2-targeted therapies for the treatment of early-stage and/or advanced-stage disease. Although oncologic outcomes continue to improve, most patients with advanced HER2-positive BC ultimately die of their disease because of primary or acquired resistance to therapy, and patients with HER2-positive early BC who have residual invasive disease after preoperative systemic therapy are at a higher risk of distant recurrence and death. The concept of treatment de-escalation and escalation is increasingly important to optimally tailor therapy for patients with HER2-positive BC and is a major focus of the current review. Research efforts in this regard are discussed as well as updates regarding the evolving standard of care in the (neo)adjuvant and metastatic settings, including the use of novel combination therapies. The authors also briefly discuss ongoing challenges in the management of HER2-positive BC (eg, intrinsic vs acquired drug resistance, the identification of predictive biomarkers, the integration of imaging techniques to guide clinical practice), and the treatment of HER2-positive brain metastases. Research aimed at superseding these challenges will be imperative to ensure continued progress in the management of HER2-positive BC going forward.

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Radiological complete remission in HER2-positive metastatic breast cancer patients: what to do with trastuzumab?

Cited by 15 publications

References 34 publications

Cardiotoxicity during long-term trastuzumab use in patients with HER2-positive metastatic breast cancer: who needs cardiac monitoring?

Cardiotoxicity during long-term trastuzumab use in patients with HER2-positive metastatic breast cancer: who needs cardiac monitoring?

Management of Breast Cancer During the COVID-19 Pandemic: A Stage- and Subtype-Specific Approach

Evolving standards of care and new challenges in the management of HER2‐positive breast cancer

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