International Journal of Clinical Oncology and Cancer Research
Volume 3, Issue 3, June 2018, Pages: 20-24
Received: Jun. 7, 2018;
Accepted: Jun. 26, 2018;
Published: Jul. 24, 2018
Views 1336 Downloads 87
Ida Micaily, Department of Internal Medicine, Abington Hospital Jefferson Health, Abington, Pennsylvania, USA
Lakshmi Kolandra, Department of Internal Medicine, Abington Hospital Jefferson Health, Abington, Pennsylvania, USA
Shahrzad Abdollahi, Department of Internal Medicine, Abington Hospital Jefferson Health, Abington, Pennsylvania, USA
Anthony Scarpaci, Department of Medical Oncology, Abington Hospital Jefferson Health, Abington Pennsylvania, USA
Metastatic hormone-receptor and HER-2 positive (triple-positive) breast cancer provides a treatment dilemma for oncologic clinicians. The current National Comprehensive Cancer Network (NCCN) Guidelines offer a variety of options in the first and second line for metastatic breast cancer. However, a more tailored treatment approach may be needed for the triple-positive metastatic breast cancer population. The aim of this study is to trend the therapeutic treatment selections for patients with metastatic, triple-positive breast cancer at a single, academic-affiliated community practice in the United States. The patient population included individuals with triple-positive, metastatic breast cancer who were treated over the span of six years at this institution. Ultimately, this patient population demonstrated variability across the various treating oncologists choice of therapy in the first, second and fourth line of treatment. The majority of patients (twelve out of fifteen) received combination therapy with trastuzumab in the first line of therapy. In the second line, seven out of eight patients received trastuzumab as part of their treatment regimen. In the third line, all three patients received trastuzumab emtansine as part of their therapy regimen. For patients who were able to survive until the fourth line and beyond, several other treatment options were utilized. Therefore, although metastatic, triple-positive breast cancer represents a subset of patients with vast treatment variability throughout the various lines of therapy, and there is a general lack of consensus on how to best treat this patient population. This study provides an opportunity for more expansive research in the field in order to help elucidate a treatment algorithm for all oncologic practitioners for patients with triple positive, metastatic breast cancer.
Metastatic Hormone and Her-2 Positive Breast Cancer: A Community Approach, International Journal of Clinical Oncology and Cancer Research.
Vol. 3, No. 3,
2018, pp. 20-24.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA: A Cancer Journal for Clinicians. 2017; 67 (1): 7-30.
Metastatic Breast Cancer Network, Metastatic Breast Cancer Incidence and Rates, Accessed: May 12, 2017.
American Joint Committee on Cancer, Cancer Staging, 2018.
Onitilo AA, Engel JM, Greenlee RT, Mukesh BN. Breast Cancer Subtypes Based on ER/PR and Her2 Expression: Comparison of Clinicopathologic Features and Survival.
Sambi M, Haq S, Samuel V, et al. Alternative therapies for metastatic breast cancer: Multimodal approach targeting tumor cell heterogeneity. Breast Cancer: Targets and Therapy. 2017; 9: 85-93.
Advani P, Cornell L, Chumsri, S, et al. Dual HER2 blockade in the neoadjuvant and adjuvant treatment of HER2-positive breast cancer. Breast Cancer: Targets and Therapy. 2015: 7 321-325.
Byunghee Y, Amol K, Ping W, et al. Therapy targeted to the metastatic niche is effective in a model of stage IV breast cancer. Scientific Reports (Nature Publisher Group). 2017; 7: 45060.
Johnson S, Roberto H, Im S, et al. Phase III, Randomized Study of Dual Human Epidermal Growth Factor Receptor 2 (HER2) Blockade with Lapatinib Plus Trastuzumab in Combination With an Aromatase Inhibitor in Postmenopausal Women With HER2-Positive, Hormone Receptor–Positive Metastatic Breast Cancer: ALTERNATIVE. Journal of Clinical Oncology. 2017; 36 741-748.
National Comprehensive Cancer Network, NCCN Guidelines Version 2. 2017.
Hernandez- Aya LF, Ma CX, Chemotherapy principles of managing stage IV breast cancer in the United States, Chinese Clinical Oncology, Vol 5, No3, June 2016.
Verma S: Clinical algorithm for HER2-positive metastatic breast cancer. 2018 Miami Breast Cancer Conference. Invited Lecture. Presented March 9, 2018.
Gelmon KA, Boyle FM, Kaufman B, et al: Lapatinib or trastuzumab plus taxane therapy for human epidermal growth factor receptor 2-positive advanced breast cancer: Final results of NCIC CTG MA. 31. J Clin Oncol 33:1574-1583, 2015.
Awada A, Colomer R, Inoue K, et al: Neratinib plus paclitaxel vs trastuzumab plus paclitaxel in previously untreated metastatic ERBB2-positive breast cancer: The NEfERT-T randomized clinical trial. JAMA Oncol 2:1557-1564, 2016.
Hurvitz SA, Andre F, Jiang Z, et al: Combination of everolimus with trastuzumab plus paclitaxel as first-line treatment for patients with HER2-positive advanced breast cancer (BOLERO-1): A phase 3, randomised, double-blind, multicentre trial. Lancet Oncol 16:816-829, 2015.
Swain SM, Baselga J, Kim, SB, et al: Pertuzumab, trastuzumab, and docetaxel in HER2-positive metastatic breast cancer. N Engl J Med 372:724-734, 2015.
Ellis PA, Barrios CH, Eiermann W, et al: Phase III, randomized study of trastuzumab emtansine ± pertuzumab vs trastuzumab + taxane for first-line treatment of HER2-positive MBC: Primary results from the MARIANNE study. 2015 ASCO Annual Meeting. Abstract 507. Presented June 1, 2015.
Verma S, Miles D, Gianni L, et al: Trastuzumab emtansine for HER2-positive advanced breast cancer. N Engl J Med 367:1783-1791, 2012.
Andre, F, O’Regan R, Ozguroglu M, et al: Everolimus for women with trastuzumab-resistant, HER2-positive, advanced breast cancer (BOLERO-3): A randomised, double-blind, placebo-controlled phase 3 trial. Lancet Oncol 15:580-591, 2014.
Harbeck N, Huang CS, Hurvitz S, et al: Afatinib plus vinorelbine versus trastuzumab plus vinorelbine in patients with HER2-overexpressing metastatic breast cancer who had progressed on one previous trastuzumab treatment (LUX-Breast 1): An open-label, randomised, phase 3 trial. Lancet Oncol 17:357-366, 2016.
Krop IE, Kim SB, González-Martín A, et al: Trastuzumab emtansine versus treatment of physician’s choice for pretreated HER2-positive advanced breast cancer (TH3RESA): A randomised, open-label, phase 3 trial. Lancet Oncol 15:689-699, 2014.
Blackwell KL, Burstein HJ, Storniolo AM, et al: Randomized study of lapatinib alone or in combination with trastuzumab in women with ErbB2-positive, trastuzumab-refractory metastatic breast cancer. J Clin Oncol 28:1124-1130, 2010.
Urruticoechea A, Rizwanullah M, Im SA, et al: PHEREXA: A phase III study of trastuzumab + capecitabine ± pertuzumab for patients who progressed during/after one line of trastuzumab-based therapy in the HER2-positive metastatic breast cancer setting. 2016 ASCO Annual Meeting. Abstract 504. Presented June 6, 2016.
Gradishar WJ, Hegg R, Im SA, et al: Phase III study of lapatinib (L) plus trastuzumab (T) and aromatase inhibitor (AI) vs T+AI vs L+AI in postmenopausal women with HER2+, HR+ metastatic breast cancer: ALTERNATIVE. 2017 ASCO Annual Meeting. Abstract 1004. Presented June 3, 2017.
Arpino G, Ferrero J-M, de la Haba-Rodriguez J, et al: Primary analysis of PERTAIN: A randomized, two-arm, open-label, multicenter phase II trial assessing the efficacy and safety of pertuzumab given in combination with trastuzumab plus an aromatase inhibitor in first-line patients with HER2-positive and hormone receptor-positive metastatic or locally advanced breast cancer. 2016 San Antonio Breast Cancer Symposium. Abstract S3-04. Presented December 8, 2016.
Barrios CH, Wuerstlein R, Anton A, et al. Safety of trastuzumab emtansine in HER2-positive advanced breast cancer patients: Primary results from KAMILLA study cohort 1. 2017 ASCO Annual Meeting. Abstract 1033. Presented June 4, 2017.
Giordano SH, Temin S, Kirshner JJ, et al: Systemic therapy for patients with advanced human epidermal growth factor receptor 2-positive breast cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol 32:2078-2099, 2014.