Phase 2 Study of a HER-2/neu Intracellular Domain Peptide-Based Vaccine Administered to Stage IV HER2 Positive Breast Cancer Patients Receiving Trastuzumab

1045 Background: Non-invasive diagnostic tools can optimize and evaluate HER2 directed therapy in HER2 positive breast cancer patients. HER2 imaging with 111In-trastuzumab SPECT showed promising results (Perik et al, J Clin Oncol. 2006). To further optimize HER2 imaging, we developed 89Zr-trastuzumab for high resolution, quantitative and sensitive PET imaging. A feasibility study was performed to determine optimal conditions (tracer dose and scans) for visualization HER2 positive lesions. Methods: Trastuzumab was labeled with 89Zr according to Verel et al. (J Nucl Med. 2003). HER-2 positive metastatic breast cancer patients received 37 MBq 89Zr-trastuzumab at 3 protein doses of trastuzumab: 1) 10 mg, or 2) 50 mg trastuzumab, or 3) 10 mg trastuzumab when on trastuzumab treatment. Patients underwent 2 or 3 PET-scans during 1–7 days post tracer injection. Images were analyzed visually and the relative tissue or tumor uptake was calculated as the ratio tissue/tumor to whole body uptake. Results: Fourteen patients were included. Optimal time point to assess 89Zr-trastuzumab tumor uptake was 4–5 days post injection. The tracer dose of 10 mg was sufficient for patients on trastuzumab treatment, while best imaging results in trastuzumab naive patients were obtained with the 50 mg dose as 10 mg resulted in rapid tracer clearance. In trastuzumab naive patients, 89Zr-trastuzumab clearance was not only dose-dependent but also clearly influenced by tumor burden, indicating a need for individualization of therapy. 89Zr-trastuzumab PET-imaging detected not only known tumor lesions in the liver, lung, bone and brain but also unknown brain and bone lesions were detected. The mean relative tumor uptake(± SD) in liver, bone and brain lesions was respectively 13.0±5.2, 4.2±1.5 and 3.5±4.2, while mean relative tissue uptake in normal liver, spleen, kidneys and brain was respectively 6.1±2.3, 2.7±0.8, 3.8±1.0 and 0.19±0.11. Conclusions: HER2-PET imaging with 89Zr-trastuzumab shows excellent tumor tracer uptake and can be used to detect HER2 positive breast cancer metastases and to quantify 89Zr-trastuzumab uptake, non-invasively. Patients on trastuzumab can be imaged with 37 MBq 89Zr-trastuzumab at a protein dose of 10 mg trastuzumab while trastuzumab naive patients require 50 mg. No significant financial relationships to disclose.

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Approachment to the Brain Metastasis without Extracranial Metastasis of the HER2 Positive Metastatic Breast Cancer

Clinical Oncology and Research ◽

10.31487/j.cor.2020.06.04 ◽

2020 ◽

pp. 1-6

Author(s):

Bala Basak Oven ◽

Altay Aliyev ◽

Bala Basak Oven ◽

Eda Tanrıkulu ◽

Ilker Nihat Okten ◽

...

Keyword(s):

Breast Cancer ◽

Brain Metastasis ◽

Cancer Patients ◽

Univariate Analysis ◽

Local Treatment ◽

Extracranial Metastasis ◽

Breast Cancer Patients ◽

Her2 Positive ◽

Her 2 ◽

Positive Breast Cancer

Introduction: Breast cancer is one of the most common malignancy that metastases to brain with the risk of 10-16%. Brain metastasis has been reported to be more common among younger women with tumors larger diameter and higher grade, hormone negative and HER2 positive ones. We reviewed inhere treatment of patients with brain metastasis without extracranial metastasis of HER-2 positive breast cancer. Patients and Method: Totally 470 HER2 positive breast cancer patients were evacuated and treatment and clinicopathological factors of 20 patients with brain progression without extracranial metastasis were revised retrospectively. Overall survival (OS) and progression free survival (PFS)and related factors were analysed with univariate analysis. Results: Median survival could not to be reached but, 3 years survival rate was 77% and median PFS was 16.1 months. Brain metastasis were treated with surgery followed with radiotherapy among 9 patients (45%) and only with radiotherapy other 11 (55%) patients. While nearly half of the patients received trastuzumab based therapy after local treatment, lapatinib-capecitabine were given to 7 (35%) and TDM-1 to 4 (20%) patients. There is no significant relation with anti-HER2 therapy in respect to OS or PFS. Conclusion: Although anti-HER2 therapy has known to be improve prognosis of HER-2 positive breast cancer with brain metastasis, there is no consensus which therapy is better. Treatment option can be based adverse effect, patient performance or cost-effectiveness until in the future prospectively designed study related the anti-HER2 therapy after local brain therapy will be come up.

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Treatment outcomes among human epidermal growth factor receptor 2 positive breast cancer patients: A systematic review

Journal of Oncology Pharmacy Practice ◽

10.1177/10781552211005530 ◽

2021 ◽

pp. 107815522110055

Author(s):

Amsalu Degu ◽

Asha Yussuf

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Treatment Outcomes ◽

Cancer Patients ◽

Growth Factor Receptor ◽

Breast Cancer Patients ◽

Her2 Positive ◽

Her2 Positive Breast Cancer ◽

Her 2 ◽

Positive Breast Cancer

Background The incidence of human epidermal growth factor receptor 2 (HER 2) positive breast cancers is rapidly rising worldwide. Although there have been many studies on HER 2 breast cancer treatment and management in recent years, there is a lack of comprehensive reports on the treatment outcomes and disparities within the available literature. Hence, this review aimed to determine the treatment outcomes and their associated factors among patients with HER2-positive breast cancer. Methods A computer-based systematic literature search was conducted using PubMed, EMBASE, and Google scholar databases of articles published from 2000 to 2020. The following key terms (HER 2 positive breast cancer, predictor, determinant, associated factor) and Medical Subject Headings (MeSH) terms (breast neoplasms, treatment outcome, and risk factors) were used to search the English language published articles. Results In most studies, trastuzumab was the most commonly used treatment regimen used in combination with chemotherapeutic agents. Generally, most of the studies (15 studies) showed that the overall survival outcome was relatively higher after treatment among HER2 positive breast cancer patients. Nonetheless, two studies showed that the absence of significant change in the overall survival despite adequate treatment was given to the study participants. In addition, three studies demonstrated a partial response after treating HER2-positive breast cancer patients. Conclusion Generally, the overall survival outcome was relatively higher after treatment among HER2 positive breast cancer patients. The addition of trastuzumab in most of the studies has shown improvement in the overall survival and the disease-free survival rate of the study patients.

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