engleski

Dual anti HER-2 therapy with pertuzumab and trastuzumab in later lines of treatment for metastatic HER2 positive breast cancer

Introduction: According to the current ASCO guidelines, trastuzumab and pertuzumab (TP) in combination with taxanes are indicated as 1st line treatment of HER2 positive metastatic breast cancer, and trastuzumabemtansine (T-DM1) as 2nd line. Due to the prolonged survival of patients with HER2 + breast cancer we occasionally encounter patients whose therapy for metastatic disease was started before the approval of pertuzumab. According to the ASCO guidelines T-DM1 can be used in the 3rd line of treatment if not already used in the 2nd line or pertuzumab if not used in the 1st or 2nd line. The aim of this study was to analyze the efficacy and tolerability of pertuzumab used as 3rd or subsequent line treatment. Methods: We conducted a retrospective chart review using the hospital information system and analyzed 4 patients with HER2 + metastatic breast cancer who received TP + vinorelbin (TPV) in late lines of treatment at the expense of the Department of Oncology at UHC Zagreb. They also received trastuzumab in combination with taxanes in the 1st line because their therapy was started before the approval of pertuzumab. Result: A case series of 4 patients treated with pertuzumab in subsequent lines of therapy, after trastuzumab with taxanes in the 1st line and T-DM1 in the 2nd line, is presented. In two patients, TPV was administered as 4th line treatment. Patient 1 (56) received 12 cycles and patient 2 (61) 10 cycles of TPV therapy until disease progression. Patient 3 (62) received 6 cycles of vinorelbine and 8 cycles of pertuzumab and trastuzumab as 5th line treatment with disease regression, but therapy was discontinued due to heart failure. Patient 4 (43) received 3 cycles in the 3rd line and partial regression of the disease was observed and she still receiving the treatment. Conclusion: In this small series of patients the effectiveness of pertuzumab with trastuzumab and vinorelbine was found despite its use in later treatment lines and earlier exposure to trastuzumab in the 1st line. In some patients who started treatment before the pertuzumab era, dual anti- HER2 blockade may be attempted in late treatment lines in accordance with the ASCO guidelines. This may delay disease progression and provide adequate dual anti-HER2 blockade for a

metastatic breast cancer ; HER2 therapy ; pertuzumab ; later lines

nije evidentirano