by Fabien Moinard-Butot, Caroline Saint-Martin, Carole
Pflumio, Matthieu Carton, William Jacot, Paul-Henri Cottu, Véronique Diéras,
Florence Dalenc, Anthony Goncalves, Marc Debled, Anne Patsouris, Marie-Ange
Mouret-Reynier, Laurence Vanlemmens, Marianne Leheurteur, George Emile,
Jean-Marc Ferrero, Isabelle Desmoulins, Lionel Uwer, Jean-Christophe Eymard,
Bianca Cheaib, Coralie Courtinard, Thomas Bachelot, Michaël Chevrot, Thierry
Petit
The Breast: VOLUME 63, P54-60, JUNE
01, 2022
Purpose
Trastuzumab-emtansine (T-DM1), as well as lapatinib plus
capecitabine were proven effective in two Phase III studies, following
first-line trastuzumab plus a taxane. The introduction of dual HER2 blockade by
trastuzumab and pertuzumab as first-line has positioned T-DM1 into second-line,
and lapatinib plus capecitabine beyond, without formal evaluation of these
strategies.
Methods
ESME Data Platform (NCT03275311) included individual data
from all patients aged ≥18 years, in whom first-line treatment for metastatic
breast cancer (MBC) was initiated between January 1, 2008 and December 31, 2016
in one of the 18 French Comprehensive Cancer Centers. The efficacy of T-DM1 and
lapatinib plus capecitabine combination, following double blockade associating
trastuzumab and pertuzumab were evaluated in this national real-life database.
Eligibility criteria were: female, MBC, HER2+ tumor, first-line taxane-based
chemotherapy and dual HER2-blockage by trastuzumab plus pertuzumab. Cohort A
received second-line T-DM1, and Cohort B second-line T-DM1 and third or
fourth-line lapatinib plus capecitabine.
Results
Cohort A comprised 233 patients, and Cohort B 47 patients.
Median progression-free survival (PFS) was 7.1 months in Cohort A and 4.6
months in Cohort B. Median overall survival were 36.7 months and 12.9 months,
respectively. PFS was significantly dependent on the preceding treatment line's
duration. In cohort A, HER2 expression status was a significant predictive
factor of PFS.
Conclusion
First-line trastuzumab plus pertuzumab do not markedly
diminish T-DM1's efficacy in second-line. Similarly, sequential treatment with
trastuzumab plus pertuzumab then T-DM1 does not noticeably modify the efficacy
of lapatinib plus capecitabine.
