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. 2017 May 25;8(34):56921-56931.
doi: 10.18632/oncotarget.18176. eCollection 2017 Aug 22.

A Retrospective Multicentric Observational Study of Trastuzumab Emtansine in HER2 Positive Metastatic Breast Cancer: A Real-World Experience

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Free PMC article

A Retrospective Multicentric Observational Study of Trastuzumab Emtansine in HER2 Positive Metastatic Breast Cancer: A Real-World Experience

Patrizia Vici et al. Oncotarget. .
Free PMC article

Abstract

We addressed trastuzumab emtansine (T-DM1) efficacy in HER2+ metastatic breast cancer patients treated in real-world practice, and its activity in pertuzumab-pretreated patients. We conducted a retrospective, observational study involving 23 cancer centres, and 250 patients. Survival data were analyzed by Kaplan Meier curves and log rank test. Factors testing significant in univariate analysis were tested in multivariate models. Median follow-up was 15 months and median T-DM1 treatment-length 4 months. Response rate was 41.6%, clinical benefit 60.9%. Median progression-free and median overall survival were 6 and 20 months, respectively. Overall, no differences emerged by pertuzumab pretreatment, with median progression-free and median overall survival of 4 and 17 months in pertuzumab-pretreated (p=0.13), and 6 and 22 months in pertuzumab-naïve patients (p=0.27). Patients who received second-line T-DM1 had median progression-free and median overall survival of 3 and 12 months (p=0.0001) if pertuzumab-pretreated, and 8 and 26 months if pertuzumab-naïve (p=0.06). In contrast, in third-line and beyond, median progression-free and median overall survival were 16 and 18 months in pertuzumab-pretreated (p=0.05) and 6 and 17 months in pertuzumab-naïve patients (p=0.30). In multivariate analysis, lower ECOG performance status was associated with progression-free survival benefit (p<0.0001), while overall survival was positively affected by lower ECOG PS (p<0.0001), absence of brain metastases (p 0.05), and clinical benefit (p<0.0001). Our results are comparable with those from randomized trials. Further studies are warranted to confirm and interpret our data on apparently lower T-DM1 efficacy when given as second-line treatment after pertuzumab, and on the optimal sequence order.

Keywords: HER2 positive; T-DM1; metastatic breast cancer; previous pertuzumab; real-world.

Conflict of interest statement

CONFLICTS OF INTEREST The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Progression-free survival (PFS, A) and overall survival (OS, B) in the overall population. No: number.
Figure 2
Figure 2
Progression-free survival (A) and overall survival (B) in patients who received T-DM1 as second-line or beyond according to pertuzumab pre-treatment. PFS: progression-free survival; OS: overall survival; No: number.

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