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Efficacy and Safety of Trastuzumab as a Single Agent in First-Line Treatment of HER2-Overexpressing Metastatic Breast Cancer
Abstract
PURPOSE: To evaluate the efficacy and safety of first-line, single-agent trastuzumab in women with HER2-overexpressing metastatic breast cancer. PATIENTS AND METHODS: One hundred fourteen women with HER2-overexpressing metastatic breast cancer were randomized to receive first-line treatment with trastuzumab 4 mg/kg loading dose, followed by 2 mg/kg weekly, or a higher 8 mg/kg loading dose, followed by 4 mg/kg weekly. RESULTS: The objective response rate was 26% (95% confidence interval [CI], 18.2% to 34.4%), with seven complete and 23 partial responses. Response rates in 111 assessable patients with 3+ and 2+ HER2 overexpression by immunohistochemistry (IHC) were 35% (95% CI, 24.4% to 44.7%) and none (95% CI, 0% to 15.5%), respectively. The clinical benefit rates in assessable patients with 3+ and 2+ HER2 overexpression were 48% and 7%, respectively. The response rates in 108 assessable patients with and without HER2 gene amplification by fluorescence in situ hybridization (FISH) analysis were 34% (95% CI, 23.9% to 45.7%) and 7% (95% CI, 0.8% to 22.8%), respectively. Seventeen (57%) of 30 patients with an objective response and 22 (51%) of 43 patients with clinical benefit had not experienced disease progression at follow-up at 12 months or later. The most common treatment-related adverse events were chills (25% of patients), asthenia (23%), fever (22%), pain (18%), and nausea (14%). Cardiac dysfunction occurred in two patients (2%); both had histories of cardiac disease and did not require additional intervention after discontinuation of trastuzumab. There was no clear evidence of a dose-response relationship for response, survival, or adverse events. CONCLUSION: Single-agent trastuzumab is active and well tolerated as first-line treatment of women with metastatic breast cancer with HER2 3+ overexpression by IHC or gene amplification by FISH.
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“Previous comparisons of different dosing regimens [75, 76] revealed that trastuzumab or rituximab Cmax did not correlate with clinical efficacy.”
From Subcutaneous Administration of Biotherapeutics: An Overview of Current Challenges and Opportunities (2018) · cites this paper as [76]
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Metadata
- Authors
- Vogel, C. L., Cobleigh, M. A., Tripathy, D., Gutheil, J. C., Harris, L. N., Fehrenbacher, L., Slamon, D. J., Murphy, M., Novotny, W. F., Burchmore, M., Shak, S., Stewart, S. J., & Press, M.
- Affiliations
- University of Southern California (US)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2002-02-01
- Volume
- 20
- Issue
- 3
- Pages
- 719-726
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W4239989216
- Cited by
- 1,860
- References
- 9
- Citations by year
- 2026: 12 · 2025: 34 · 2024: 52 · 2023: 75 · 2022: 113 · 2021: 67 · 2020: 72 · 2019: 62 · 2018: 97 · 2017: 95 · 2016: 87 · 2015: 88 · 2014: 71 · 2013: 91 · 2012: 74
- FWCI
- 32.63
- Type
- journal article
- Language
- en
- Update notices
- new_edition (2023-03-15)
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- Funders
- National Cancer Institute (CA48780)
- Topics
- Health Sciences › Medicine › Oncology › HER2/EGFR in Cancer Research
- Health Sciences › Medicine › Oncology › Gastric Cancer Management and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Treatments and Mutations
- Keywords
- trastuzumab, HER2-positive breast cancer, metastatic breast cancer, first-line therapy, single-agent chemotherapy, HER2 immunohistochemistry, HER2 amplification, objective response rate, adverse cardiac events, dose-response relationship, treatment safety
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