Early immune modulation by single-agent trastuzumab as a marker of trastuzumab benefit

Tiziana Triulzi, Viola Regondi, Loris De Cecco, Maria Rosa Cappelletti, Martina Di Modica, Biagio Paolini, Pier Luigi Lollini, Serena Di Cosimo, Lucia Sfondrini, Daniele Generali, Elda Tagliabue

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Optimising the selection of HER2-targeted regimens by identifying subsets of HER2-positive breast cancer (BC) patients who need more or less therapy remains challenging. We analysed BC samples before and after treatment with 1 cycle of trastuzumab according to the response to trastuzumab.

METHODS: Gene expression profiles of pre- and post-treatment tumour samples from 17 HER2-positive BC patients were analysed on the Illumina platform. Tumour-associated immune pathways and blood counts were analysed with regard to the response to trastuzumab. HER2-positive murine models with differential responses to trastuzumab were used to reproduce and better characterise these data.

RESULTS: Patients who responded to single-agent trastuzumab had basal tumour biopsies that were enriched in immune pathways, particularly the MHC-II metagene. One cycle of trastuzumab modulated the expression levels of MHC-II genes, which increased in patients who had a complete response on treatment with trastuzumab and chemotherapy. Trastuzumab increased the MHC-II-positive cell population, primarily macrophages, only in the tumour microenvironment of responsive mice. In patients who benefited from complete trastuzumab therapy and in mice that harboured responsive tumours circulating neutrophil levels declined, but this cell subset rose in nonresponsive tumours.

CONCLUSIONS: Short treatment with trastuzumab induces local and systemic immunomodulation that is associated with clinical outcomes.

Original languageEnglish
Pages (from-to)1487-1494
Number of pages8
JournalBritish Journal of Cancer
Issue number12
Publication statusPublished - Dec 2018


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