Termination of trastuzumab in HER2-positive metastatic breast cancer patients who received trastuzumab beyond progression

Abstract

The purpose of the study was to assess the prognosis of HER2-positive metastatic breast cancer patients who received trastuzumab beyond progression and investigate the predictors of complete response. HER2-positive metastatic breast cancer patients who received long-term trastuzumab were included in the study. Predictors of complete response were analyzed with binary regression analysis. The prognosis of patients who had their trastuzumab-based treatment terminated was assessed. Eighty patients were involved in the study. The patients were received with trastuzumab for a median of 62 months (12–191). A complete response was observed in 60 (75%) patients. The median duration to development of complete response was found as 14.8 months (2.4–55). In logistic regression analysis: using endocrine therapy with trastuzumab (p = 0.04), menopausal status (p = 0.03), and the number of metastatic sites (p = 0.01) were found to be statistically significant factors for a complete response. Trastuzumab-based therapy of fifteen patients was terminated, six (40%) patients continued to receive an aromatase inhibitor, and nine (60%) patients were followed up without treatment. After termination of trastuzumab, at a median follow-up of 32 months (11–66), recurrence was detected in two (13.3%) patients. We detected that menopausal status, the number of metastatic sites, and using endocrine therapy with trastuzumab were predictors of complete response in HER2-positive metastatic breast cancer patients who received long-term trastuzumab-based therapy. We observed that HER2-positive metastatic breast cancer patients may be completely cured with trastuzumab-based therapy. There are no defined criteria for termination of trastuzumab treatment in this selected patient group. It is necessary to confirm our data with multicenter studies involving a large number of patients.

Novel insights into cardiovascular toxicity of cancer targeted and immune therapies: Beyond ischemia with non-obstructive coronary arteries (INOCA)

“…Combination of trastuzumab with chemotherapy results in substantial improvement in progression-free survival and overall survival for both metastatic and localized HER-2 + breast cancer [ [19] , [20] , [21] ]. In clinically localized HER-2 + breast cancer, treatment for 12 months with trastuzumab is there standard of care; however, in the metastatic setting, patients are continued on treatment until progression which can be many years (median PFS 102 months) [ 22 , 23 ] Trastuzumab's efficacy, however, comes at the expense of cardiovascular toxicity with an incidence up to 28 % [ 20 , 24 , 25 ]. Cardiovascular toxicity was not limited to patients who received trastuzumab concurrent with anthracycline, which is a known cardiac toxin, but also was seen in patients who received other chemotherapeutic agents, such as paclitaxel, with 13 % of patients receiving trastuzumab and this microtubule inhibitor developing cardiac toxicity [ 24 ].…”

From Reductionistic Approach to Systems Immunology Approach for the Understanding of Tumor Microenvironment

“…The review of the literature in this essay suggests that doing more of the same without considering the complexity of the TME would not result in a different outcome in the curative treatment of breast cancer. In fact, breaking down various therapies into a single cell type or signaling pathway like anti-CTLA4 immunotherapy [82], anti-PD-L1 immunotherapy [83], CAR-NK cell therapy [84], and antibody therapies [85] exemplify the shortcomings of this approach, given the fact that none of these therapies could offer a cure to cancer patients. One reason for the transient efficacy of such immunotherapies is that it would take time for an altered immune pattern within the TME to control new anti-tumor T cells by forcing them to adapt to the TME.…”