PMID- 27563438 OWN - NLM STAT- PubMed-not-MEDLINE DCOM- 20160826 LR - 20200930 IS - 2078-6891 (Print) IS - 2219-679X (Electronic) IS - 2078-6891 (Linking) VI - 7 IP - 4 DP - 2016 Aug TI - Continuation of trastuzumab beyond disease progression in HER2-positive metastatic gastric cancer: the MD Anderson experience. PG - 499-505 LID - 10.21037/jgo.2016.06.16 [doi] AB - BACKGROUND: Despite the wide spread use of trastuzumab in human epidermal growth factor receptor 2 (HER2) overexpressing metastatic gastric cancer patients, its optimal duration of administration beyond first-line disease progression is unknown. In HER2 overexpressing metastatic breast cancer, trastuzumab continuation beyond first-line disease progression has shown improvement in time to progression (TTP) without an increased risk of treatment related toxicity. METHODS: HER2-overexpressing metastatic gastric cancer patients were identified from our database between January 2010 and December 2014. We retrospectively reviewed the medical records of 43 patients who received trastuzumab in combination with chemotherapy as first-line and continued trastuzumab beyond disease progression. RESULTS: Forty-three cases were identified, 27 males (62.8%), median age of the patients was 58 years. Thirty-five (81.4%) presented with stage 4 as their initial presentation. Eighty one percent had 3+ HER2 overexpression by immunohistochemistry (IHC) and 18% had 2+ HER2 overexpression confirmed by fluorescence in situ hybridization (FISH). Thirteen (52%) were moderately differentiated, 16 (37.1%) were poorly differentiated. The most common sites of metastasis were liver 35 (81.4%) and lung 14 (32.5%). The most commonly used first-line regimen was oxaliplatin, 5-fluorouracil (5-FU), and trastuzumab in 22 (51.1%) patients. Twenty-five (58.1%) patients received irinotecan, 5-FU and trastuzumab in the second-line. Progression-free survival (PFS) was 5 months (95% CI: 4.01-5.99 months). Five patients are still alive and excluded from calculating the median overall survival (OS) which was 11 months (range, 5-53 months) for the remaining 20 subjects of this second-line group. Trastuzumab was not discontinued due to side effects in any of the study population. CONCLUSIONS: In conclusion, this retrospective analysis suggests that continuation of trastuzumab beyond disease progression in patients with HER2-overexpressing metastatic gastric cancer is feasible and safe. Randomized studies are warranted. FAU - Al-Shamsi, Humaid O AU - Al-Shamsi HO AD - Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Fahmawi, Yazan AU - Fahmawi Y AD - Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Dahbour, Ibrahim AU - Dahbour I AD - Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Tabash, Aziz AU - Tabash A AD - Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Rogers, Jane E AU - Rogers JE AD - Pharmacy Clinical Programs, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Mares, Jeannette Elizabeth AU - Mares JE AD - Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Blum, Mariela A AU - Blum MA AD - Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Estrella, Jeannelyn AU - Estrella J AD - Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Matamoros, Aurelio Jr AU - Matamoros A Jr AD - Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Sagebiel, Tara AU - Sagebiel T AD - Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Devine, Catherine E AU - Devine CE AD - Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Badgwell, Brian D AU - Badgwell BD AD - Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Lin, Quan D AU - Lin QD AD - Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Das, Prajnan AU - Das P AD - Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. FAU - Ajani, Jaffer A AU - Ajani JA AD - Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. LA - eng PT - Journal Article PL - China TA - J Gastrointest Oncol JT - Journal of gastrointestinal oncology JID - 101557751 PMC - PMC4963369 OTO - NOTNLM OT - Gastric cancer OT - human epidermal growth factor receptor 2 (HER2) OT - trastuzumab COIS- Conflicts of Interest: The authors have no conflicts of interest to declare. EDAT- 2016/08/27 06:00 MHDA- 2016/08/27 06:01 PMCR- 2016/08/01 CRDT- 2016/08/27 06:00 PHST- 2016/08/27 06:00 [entrez] PHST- 2016/08/27 06:00 [pubmed] PHST- 2016/08/27 06:01 [medline] PHST- 2016/08/01 00:00 [pmc-release] AID - jgo-07-04-499 [pii] AID - 10.21037/jgo.2016.06.16 [doi] PST - ppublish SO - J Gastrointest Oncol. 2016 Aug;7(4):499-505. doi: 10.21037/jgo.2016.06.16.