scholarly journals Factors affecting disease-free survival in patients with human epidermal growth factor receptor 2-positive breast cancer who receive adjuvant trastuzumab

2015 ◽  
Vol 3 (5) ◽  
pp. 1109-1112 ◽  
Author(s):  
SEYDA GÜNDÜZ ◽  
SEMA SEZGIN GÖKSU ◽  
DENIZ ARSLAN ◽  
ALI MURAT TATLI ◽  
MÜKREMIN UYSAL ◽  
...  
2018 ◽  
Vol 71 (11-12) ◽  
pp. 394-403
Author(s):  
Bojana Vranjkovic ◽  
Dragana Petrovic ◽  
Jelena Radic ◽  
Maja Popovic ◽  
Kolarov Bjelobrk ◽  
...  

Introduction. This retrospective study evaluates the association between the time of chemotherapy initiation and disease free survival in regard to breast cancer subtypes and stage at diagnosis. Material and Methods. The study included a total of 1075 breast cancer patients, stages I - III, treated at Oncology Institute of Vojvodina, Serbia (from 2010 to 2012; n = 617). The gathered data included prognostic factors used in everyday practice. Patients were divided into three groups according to the interval between surgery and chemotherapy (? 30, 31 - 60, ? 61 days). Disease free survival was calculated. Results. Among the 617 patients, the 5-year disease free survival estimate was similar: 81.5%, 81.0%, 84.6% (log-rank test, p = 0.728) regarding the time of adjuvant chemotherapy initiation: ? 30 days, 31 - 60, and ? 61 days, respectively. The study showed that 85% of our breast cancer patients started adjuvant chemotherapy within 3 months after definitive surgery. In multivariate analysis, independent prognostic factors for disease free survival were nodal status and tumor size. The 5-year disease free survival estimate was 85.8% (p = 0.001) for patients with luminal- A subtype (Estrogen +, Progesterone high, human epidermal growth factor receptor 2-, Ki-67 < 20%) with a median follow-up of 62,7 months; for patients with luminal-B (Luminal B (human epidermal growth factor receptor 2 -) Estrogen +, human epidermal growth factor receptor 2-, either Ki-67 high or Progesterone low, Luminal B (human epidermal growth factor receptor +) Estrogen +, human epidermal growth factor receptor 2 +, any Ki-67, any Progesterone) 78.3% (p = 0.534) with a median follow-up of 55.9 months; for patients with triple negative breast cancer it was 73.4% with a median follow-up of 58,1 months, and for patients with human epidermal growth factor receptor 2+ it was 77.1% (p = 0.448) with a median follow-up of 55.5 months. Conclusion. Early initiation of adjuvant chemotherapy is particularly important in patients with advanced- stage breast cancer at diagnosis, and those with trastuzumab- treated triple-negative breast cancer and human epidermal growth factor receptor 2-positive tumors.


2011 ◽  
Vol 2011 ◽  
pp. 1-16 ◽  
Author(s):  
Sejal Shah ◽  
Beiyun Chen

Human epidermal growth factor receptor 2 (HER2) is an important prognostic and predictive factor in breast cancer. HER2 is overexpressed in approximately 15%–20% of invasive breast carcinomas and is associated with earlier recurrence, shortened disease free survival, and poor prognosis. Trastuzumab (Herceptin) a “humanized” monoclonal antibody targets the extracellular domain of HER2 and is widely used in the management of HER2 positive breast cancers. Accurate assessment of HER2 is thus critical in the management of breast cancer. The aim of this paper is to present a comprehensive review of HER2 with reference to its discovery and biology, clinical significance, prognostic value, targeted therapy, current and new testing modalities, and the interpretation guidelines and pitfalls.


2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 7034-7034 ◽  
Author(s):  
Si-Yu Wang ◽  
Haibo Sun ◽  
Wei Ou ◽  
Qin Fang

7034 Background: Mutations in the epidermal growth factor receptor (EGFR) are associated with response to chemotherapy in patients with advance NSCLC. The purpose of this study was to assess the association of mutations in the EGFR tyrosine kinase domain and the efficacy of adjuvant chemotherapy in patients with fully resected IIIA-N2 NSCLC tumors. Methods: Tumor samples (n =150) from patients in our prior trial with IIIA-N2 NSCLC who either had or had not received paclitaxel/vinorelbine plus carboplatin chemotherapy following removal of the tumor were analyzed for EGFR mutations in exons 19 and 21. The association of the presence of EGFR mutations and survival following treatment was assessed. Results: Mutations were identified in 33 (22%) patients (n=13 in the no chemotherapy [observation] arm and n=20 in the chemotherapy arm). Fourteen patients (9.3%) had deletion mutations in exon 19, and 19 patients (12.7%) had a substitution mutation in exon 21. Compared with patients wild-type for EGFR, patients with EGFR mutations had numerical but not statistically significant improved disease-free survival (35 months [95% CI, 14.6-55.4] versus 23 months [95% CI, 17.3-28.7], respectively, P=0.339) and overall survival (36 months [95% CI, 27.9 to 44.1] versus 26 months [95% CI, 20.1 to 31.9], respectively p=0.271) regardless of treatment. Patients with wild-type EGFR had greater overall survival with chemotherapy compared to no adjuvant therapy (HR=1.920; 95%CI, 1.245-2.963; p=0.003). In contrast, EGFR mutant patients in the observation group compared to the chemotherapy group had longer median disease-free survival (35 months [95% CI, 20.9 to 49.1] versus 27 months [95% CI, 5.3 to 48.7], respectively, p=0.671) and overall survival (33 months [95% CI, 24.2 to 41.8] versus 40 months [95% CI, 31.8 to 48.2] respectively, p =0.360). Conclusions: In this study, the status of mutations in exons 19 and 21 of EGFR was associated with different clinical outcomes in patients with resected IIIA-N2 NSCLC tumors either treated with or without adjuvant chemotherapy. These findings suggest that a patient’s treatment should be customized to their EGFR mutational status.


2019 ◽  
Vol 50 (1) ◽  
pp. 3-11
Author(s):  
Takayuki Ueno ◽  
Norikazu Masuda ◽  
Nobuaki Sato ◽  
Shoichiro Ohtani ◽  
Jun Yamamura ◽  
...  

Abstract Background The original aim of this study was to evaluate the treatment sequence and anthracycline requirement in docetaxel, cyclophosphamide and trastuzumab therapy. After one death in the anthracycline-containing arm, the protocol was amended to terminate the randomization. The single-docetaxel, cyclophosphamide and trastuzumab arm was continued to examine the efficacy and safety of the anthracycline-free regimen. Methods Women with human epidermal growth factor receptor-2-positive, operable and primary breast cancer were randomized to receive 5-fluorouracil, epirubicin and cyclophosphamide (four cycles) followed by docetaxel, cyclophosphamide and trastuzumab (four cycles), or docetaxel, cyclophosphamide and trastuzumab followed by 5-fluorouracil, epirubicin and cyclophosphamide, or docetaxel, cyclophosphamide and trastuzumab (six cycles). After the protocol amendment, patients were allocated to the docetaxel, cyclophosphamide and trastuzumab arm alone. The primary endpoint was a pathological complete response. Results In total, 103 patients were enrolled between September 2009 and September 2011: 21, 22 and 24 patients in the 5-fluorouracil, epirubicin and cyclophosphamide followed by docetaxel, cyclophosphamide and trastuzumab; docetaxel, cyclophosphamide and trastuzumab followed by 5-fluorouracil, epirubicin and cyclophosphamide and docetaxel, cyclophosphamide and trastuzumab arms, respectively, and 36 patients in the docetaxel, cyclophosphamide and trastuzumab arm after the protocol amendment. In total, 60 patients were allocated to the docetaxel, cyclophosphamide and trastuzumab arm, in which the pathological complete response rate was 45.8%, and disease-free survival at 3 years was 96.6%. Patients with stage I or IIA in the docetaxel, cyclophosphamide and trastuzumab arm showed good disease-free survival (100% at 3 years). The comparison of efficacy among the three arms was statistically underpowered. Left ventricular ejection fraction decreased significantly after 5-fluorouracil, epirubicin and cyclophosphamide followed by docetaxel–docetaxel, cyclophosphamide and trastuzumab (P = 0.017), but not after docetaxel, cyclophosphamide and trastuzumab followed by 5-fluorouracil, epirubicin and cyclophosphamide or docetaxel, cyclophosphamide and trastuzumab. Conclusions The pathological complete response rate for docetaxel, cyclophosphamide and trastuzumab was similar to previous reports of anthracycline-containing regimens. Docetaxel, cyclophosphamide and trastuzumab might be an option for primary systemic therapy in human epidermal growth factor receptor-2-positive early breast cancer. A larger confirmatory study is necessary.


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