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Pizzuti L, Krasniqi E, Barchiesi G, Della Giulia M, Izzo F, Sanguineti G, Marchetti P, Mazzotta M, Giusti R, Botticelli A, Gamucci T, Natoli C, Grassadonia A, Tinari N, Iezzi L, Tomao S, Tomao F, Tonini G, Santini D, Astone A, Michelotti A, De Angelis C, Mentuccia L, Vaccaro A, Magnolfi E, Gelibter A, Magri V, Cortesi E, D'Onofrio L, Cassano A, Rossi E, Cazzaniga M, Moscetti L, Omarini C, Piacentini F, Fabbri MA, Scinto AF, Corsi D, Carbognin L, Bria E, La Verde N, Samaritani R, Garufi C, Barni S, Mirabelli R, Sarmiento R, Veltri EM, D'Auria G, Paris I, Giotta F, Lorusso V, Cardillo F, Landucci E, Mauri M, Ficorella C, Roselli M, Adamo V, Ricciardi GRR, Russo A, Berardi R, Pistelli M, Fiorio E, Cannita K, Sini V, D'Ostilio N, Foglietta J, Greco F, Zamagni C, Garrone O, Di Cocco B, Baldini E, Livi L, Desideri I, Meattini I, Sarobba G, Del Medico P, De Tursi M, Generali D, De Maria R, Risi E, Ciliberto G, Sperduti I, Villa A, Barba M, Di Leo A, Vici P. Distinct HR expression patterns significantly affect the clinical behavior of metastatic HER2+ breast cancer and degree of benefit from novel anti-HER2 agents in the real world setting. Int J Cancer 2019; 146:1917-1929. [PMID: 31330065 PMCID: PMC7027476 DOI: 10.1002/ijc.32583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/07/2019] [Accepted: 07/03/2019] [Indexed: 12/02/2022]
Abstract
We analyzed data from 738 HER2‐positive metastatic breast cancer (mbc) patients treated with pertuzumab‐based regimens and/or T‐DM1 at 45 Italian centers. Outcomes were explored in relation to tumor subtype assessed by immunohistochemistry (IHC). The median progression‐free survival at first‐line (mPFS1) was 12 months. Pertuzumab as first‐line conferred longer mPFS1 compared to other first‐line treatments (16 vs. 9 months, p = 0.0001), regardless of IHC subtype. Median PFS in second‐line (mPFS2) was 7 months, with no difference by IHC subtype, but it was more favorable with T‐DM1 compared to other agents (7 vs. 6 months, p = 0.03). There was no PFS2 gain in patients with tumors expressing both hormonal receptors (HRs; p = 0.17), while a trend emerged for tumors with one HR (p = 0.05). Conversely, PFS2 gain was significant in HRs‐negative tumors (p = 0.04). Median overall survival (mOS) was 74 months, with no significant differences by IHC subtypes. Survival rates at 2 and 3 years in patients treated with T‐DM1 in second‐line after pertuzumab were significantly lower compared to pertuzumab‐naïve patients (p = 0.01). When analyzed by IHC subtype, the outcome was confirmed if both HRs or no HRs were expressed (p = 0.02 and p = 0.006, respectively). Our results confirm that HRs expression impacts the clinical behavior and novel treatment‐related outcomes of HER2‐positive tumors when treatment sequences are considered. Moreover, multivariate analysis showed that HRs expression had no effect on PFS and OS. Further studies are warranted to confirm our findings and clarify the interplay between HER2 and estrogen receptor pathways in HER2‐positive (mbc) patients. What's new? About half of breast cancers positive for human epidermal growth factor (HER2) also express hormone receptors but the impact of hormone receptor status on the success of HER2‐directed treatments is not fully explored. Here the authors retrospectively assessed tumor behavior and treatment outcomes in 738 women with HER2+ metastatic breast cancer treated with new generation anti‐HER2 agents. Distinct hormone receptor expression patterns significantly affected the progression free and overall survival, justifying further studies to define optimal treatment regimens and the interplay between hormone receptor and HER2 signaling.
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Affiliation(s)
- Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giacomo Barchiesi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marina Della Giulia
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fiorentino Izzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy.,Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy
| | - Marco Mazzotta
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Sant'Andrea, Rome, Italy
| | | | | | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Laura Iezzi
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Silverio Tomao
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, 'Sapienza' University of Rome, Policlinico Umberto I, Rome, Italy
| | - Federica Tomao
- Department of Gynecology-Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe Tonini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Daniele Santini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Antonio Astone
- Division of Medical Oncology, Villa San Pietro Hospital, Rome, Italy
| | - Andrea Michelotti
- UO Oncologia Medica I, S. Chiara Hospital, Dipartimentodi Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Claudia De Angelis
- UO Oncologia Medica I, S. Chiara Hospital, Dipartimentodi Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | | | | | - Alain Gelibter
- Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy
| | | | - Enrico Cortesi
- Medical Oncology Unit B, Policlinico Umberto I, Rome, Italy
| | - Loretta D'Onofrio
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Alessandra Cassano
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy.,Universita Cattolica del Sacro Cuore, Roma
| | - Ernesto Rossi
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy
| | - Marina Cazzaniga
- Research Unit Phase I trials and Oncology Unit, ASST Monza, Monza, Italy
| | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Claudia Omarini
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Federico Piacentini
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Maria A Fabbri
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | - Angelo F Scinto
- Medical Oncology Unit, Fatebenefratelli Hospital, Rome, Italy
| | - Domenico Corsi
- Medical Oncology Unit, Fatebenefratelli Hospital, Rome, Italy
| | - Luisa Carbognin
- Gynecology Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Emilio Bria
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy.,Universita Cattolica del Sacro Cuore, Roma
| | - Nicla La Verde
- Oncology Unit, ASST Fatebenefratelli Sacco Presidio Ospedaliero Fatebenefratelli, Milano, Italy
| | | | - Carlo Garufi
- Division of Medical Oncology, Pescara Hospital, Pescara, Italy
| | - Sandro Barni
- Department of Oncology, Oncology Unit, ASST Bergamo Ovest, Treviglio, Italy
| | - Rosanna Mirabelli
- Department of Hematology & Oncology, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy
| | | | - Enzo M Veltri
- Oncology Unit, S. Maria Goretti Hospital, Latina, Italy
| | | | - Ida Paris
- Gynecology Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Giotta
- Department of Medical Oncology, "Giovanni PaoloII" Institute, Bari, Italy
| | - Vito Lorusso
- Department of Medical Oncology, "Giovanni PaoloII" Institute, Bari, Italy
| | | | - Elisabetta Landucci
- UO Oncologia Medica I, S. Chiara Hospital, Dipartimentodi Oncologia, Dei Trapianti e Delle Nuove Tecnologie, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Maria Mauri
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | - Corrado Ficorella
- Medical Oncology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Mario Roselli
- Department of Systems Medicine, Medical Oncology, University of Rome "Tor Vergata", Rome, Italy
| | - Vincenzo Adamo
- Medical Oncology Unit A.O. Papardo & Department Human Pathology University of Messina
| | | | - Antonio Russo
- Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology, University of Palermo, Palermo, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Mirco Pistelli
- Oncology Clinic, Università Politecnica delle Marche, Ospedali Riuniti di Ancona, Ancona, Italy
| | - Elena Fiorio
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Katia Cannita
- Medical Oncology, St. Salvatore Hospital, L'Aquila, Italy
| | - Valentina Sini
- Oncology Unit, ASL Roma 1, Santo Spirito Hospital, Rome, Italy
| | | | | | - Filippo Greco
- Department of Pathology, Surgery and Oncology, "Mater Salutis" Hospital, ULSS21, Verona, Italy
| | - Claudio Zamagni
- Medical Oncology Unit, Addarii Institute of Oncology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Ornella Garrone
- Medical Oncology, A.O. Ospedale di Insegnamento S. Crocee Carle, Cuneo, Italy
| | | | | | - Lorenzo Livi
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences "Mario Serio", Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Isacco Desideri
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences "Mario Serio", Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences "Mario Serio", Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | | | - Pietro Del Medico
- Division of Medical Oncology, Reggio Calabria General Hospital, Reggio Calabria, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences, Centro Scienze dell'Invecchiamento e Medicina Traslazionale -CeSI-MeT, Chieti, Italy
| | - Daniele Generali
- Breast Cancer Unit & Translational Research Unit, ASST Cremona, Cremona, Italy
| | - Ruggero De Maria
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy.,Universita Cattolica del Sacro Cuore, Roma
| | - Emanuela Risi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Sperduti
- Bio-Statistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alice Villa
- Department of Medical Oncology, Policlinico Universitario "A. Gemelli", Rome, Italy.,Universita Cattolica del Sacro Cuore, Roma
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Angelo Di Leo
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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