Outcomes for the first four lines of therapy in patients with HER2-positive advanced breast cancer: results from the SONABRE registry

K.I.E. Ibragimova, S.M.E. Geurts, M. Meegdes, F. Erdkamp, J.B. Heijns, J. Tol, B.E.P.J. Vriens, M.W. Dercksen, K.N.A. Aaldering, M.J.A.E. Pepels, L. van de Winkel, N.A.J.B. Peters, N.J.A. Teeuwen-Dedroog, I.J.H. Vriens, V.C.G. Tjan-Heijnen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose We assessed the systemic treatment choices and outcomes in patients diagnosed with human epidermal growth factor receptor-2-positive (HER2 +) advanced breast cancer (ABC), for the first four lines of systemic therapy and by hormone receptor (HR) status.Methods We identified 330 patients diagnosed with HER2 + ABC in 2013-2018 in the Southeast of The Netherlands, of whom 64% with HR + /HER2 + and 36% with HR-/HER2 + disease. Overall survival (OS) from start of therapy was calculated using the Kaplan-Meier method.Results In real world, 95% of patients with HR + /HER2 + and 74% of patients with HR-/HER2 + disease received systemic therapy. In HR + /HER2 + disease, use of endocrine, chemo- and HER2-targeted therapy was , respectively, 64%, 46% and 60% in first line, and 39%, 64% and 75% in fourth line. In HR-/HER2 + disease, 91-96% of patients received chemotherapy and 77-91% HER2-targeted therapy, irrespective of line of therapy. In patients with HR + /HER2 + disease, median OS was 34.9 months (95%CI:25.8-44.0) for the first line and 12.8 months (95%CI:10.7-14.9) for the fourth line. In HR-/HER2 + disease, median OS was 39.9 months (95%CI:23.9-55.8) for the first line and 15.2 months (95%CI:10.9-19.5) for the fourth line. For patients treated with first-line pertuzumab, trastuzumab plus chemotherapy, median OS was not reached at 56.0 months in HR + /HER2 + disease and 48.4 months (95%CI:32.6-64.3) in HR-/HER2 + disease.Conclusion Survival times for later lines of therapy are surprisingly long and justify the use of multiple lines of systemic therapy in well-selected patients with HER2 + ABC. Our real-world evidence adds valuable observations to the accumulating evidence that within HER2 + ABC, the HR status defines two distinct disease subtypes.
Original languageEnglish
Pages (from-to)239-251
Number of pages13
JournalBreast Cancer Research and Treatment
Issue number2
Early online date1 Jan 2023
Publication statusPublished - Apr 2023


  • Breast neoplasms
  • Neoplasm metastasis
  • ERBB2 protein
  • Registries
  • Pertuzumab
  • Treatment Outcome
  • PLUS

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