• Matteo Lambertini, Arlindo R Ferreira, Antonio Di Meglio, Francesca Poggio, Fabio Puglisi, Federico Sottotetti, Filippo Montemurro, Elena Poletto, Antonio Bernardo, Emanuela Risi, Chiara Dellepiane, Valent... more ina Sini, Gabriele Minuti, Donatella Grasso, Sara Fancelli, and Lucia Del Mastro. less
• Breast Cancer Translational Research Laboratory, Institut Jules Bordet, and l'Université Libre de Bruxelles, Brussels, Belgium; Department of Medicine, BrEAST Data Center, Institut Jules Bordet, and l'Univ... more ersité Libre de Bruxelles, Brussels, Belgium. Electronic address: matteo.lambertini85@gmail.com. less
• Clin. Breast Cancer. 2017 Dec 1; 17 (8): 601-610.e2.

BackgroundThe aim of the study was to compare the patterns of care and clinical outcomes of HER2-positive metastatic breast cancer (MBC) patients with de novo or recurrent disease who underwent first-line trastuzumab-based therapy.Patients And MethodsThis was a multicenter retrospective cohort study including consecutive patients with HER2-positive MBC who received first-line trastuzumab-based therapy. Analyses on treatment response and effectiveness were conducted according to type of metastatic presentation (ie, de novo vs. recurrent disease). Exploratory analyses were used to evaluate whether the use of surgery of the primary tumor in the de novo cohort influenced patients' survival.ResultsFrom January 2000 to December 2013, 416 patients were included in the study, 113 (27.2%) presented with de novo MBC and 303 (72.8%) with recurrent disease. Compared with patients in the recurrence cohort, those in the de novo cohort had worse baseline characteristics, received more aggressive first-line treatments, and showed better survival, with an adjusted hazard ratio (HR) for progression-free survival (PFS) of 0.65 (95% confidence interval [CI], 0.43-0.97; P = .035) and for overall survival (OS) of 0.53 (95% CI, 0.30-0.95; P = .034). In the de novo cohort, the 54 patients (47.8%) who underwent surgery of the primary tumor had significantly better PFS (adjusted HR, 0.44; 95% CI, 0.26-0.72; P = .001) and OS (adjusted HR, 0.49; 95% CI, 0.26-0.93; P = .029) than those who did not undergo surgery.ConclusionPatients with de novo HER2-positive MBC showed significantly better survival outcomes than those with recurrent disease. In this population, surgery of the primary breast tumor was associated with better outcomes.Copyright © 2017 Elsevier Inc. All rights reserved.

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