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Narayanan S, Ngui NK, Kinchington B, Choi JDW, Hughes TMD, Rutovitz J, Hasovits C, Nahar KJ, Edirimanne S, Marx G. Pathological and clinical outcomes following neoadjuvant dual HER2 therapy for early-stage breast cancer: An Australian institutional real-world experience. Cancer Med 2024; 13:e7325. [PMID: 38899493 PMCID: PMC11187540 DOI: 10.1002/cam4.7325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/02/2024] [Accepted: 05/12/2024] [Indexed: 06/21/2024] Open
Abstract
AIM There has been significant progress made in developing novel targeted therapies in the neoadjuvant setting for non-metastatic HER2-positive breast cancer, which may be used in combination with conventional chemotherapy to optimise pathological responses at surgery. However, these therapies, particularly the chemotherapeutic components, may portend significant and long-lasting toxicity. Hence, de-escalation of treatment intensity has been an area of interest and was evaluated in the phase II NeoSphere study. Herein, we report the real-world pathological and survival outcomes from neoadjuvant taxane and dual HER2 blockade recorded at our centre. METHODS This was a retrospective cohort study of patients receiving neoadjuvant pertuzumab, trastuzumab and taxane chemotherapy for non-metastatic HER2-positive breast cancer at a single centre in Sydney, Australia. We collected data pertaining to baseline demographic characteristics, pathological response rates, post-surgical prescribing patterns and also undertook survival analyses for invasive disease-free survival (iDFS) as well as exploratory analyses for correlations between pre-specified clinicopathologic factors and pathological response at surgery. RESULTS Our population was largely similar at baseline to the NeoSphere study. 71 patients were included in the final analysis. 61% achieved a pathological complete response (pCR). Three patients received conventional chemotherapy in the adjuvant setting. 92% of included patients were alive and disease-free at 3 years of follow-up. Only 3 events of recurrence or death were recorded at a median follow-up of 32 months. No significant difference in iDFS was noted between patients achieving pCR and those with residual disease at surgery. CONCLUSION This study demonstrates that de-escalated adjuvant treatment for HER2-positive early breast cancer achieved favourable pathological and long-term outcomes comparable to large trials, some utilising more intensive chemotherapeutic components.
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Affiliation(s)
- Sathya Narayanan
- Cancer Services, Sydney Adventist HospitalSydneyNew South WalesAustralia
- Macquarie UniversitySydneyNew South WalesAustralia
- Northern Haematology and Oncology GroupSydney Adventist HospitalSydneyNew South WalesAustralia
| | - Nicholas K. Ngui
- Cancer Services, Sydney Adventist HospitalSydneyNew South WalesAustralia
- School of Medicine and PsychologyThe Australian National UniversityCanberraAustralia
- Northern Surgical OncologySydney Adventist HospitalSydneyAustralia
| | - Ben Kinchington
- School of Medicine and PsychologyThe Australian National UniversityCanberraAustralia
| | - Joseph Do Woong Choi
- Cancer Services, Sydney Adventist HospitalSydneyNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
| | - Thomas Michael D. Hughes
- Cancer Services, Sydney Adventist HospitalSydneyNew South WalesAustralia
- School of Medicine and PsychologyThe Australian National UniversityCanberraAustralia
- Northern Surgical OncologySydney Adventist HospitalSydneyAustralia
| | - Josie Rutovitz
- Cancer Services, Sydney Adventist HospitalSydneyNew South WalesAustralia
- Northern Haematology and Oncology GroupSydney Adventist HospitalSydneyNew South WalesAustralia
| | - Csilla Hasovits
- Cancer Services, Sydney Adventist HospitalSydneyNew South WalesAustralia
- Northern Haematology and Oncology GroupSydney Adventist HospitalSydneyNew South WalesAustralia
| | - Kazi J. Nahar
- Cancer Services, Sydney Adventist HospitalSydneyNew South WalesAustralia
- Northern Haematology and Oncology GroupSydney Adventist HospitalSydneyNew South WalesAustralia
- Melanoma Institute AustraliaSydneyNew South WalesAustralia
| | - Senarath Edirimanne
- Cancer Services, Sydney Adventist HospitalSydneyNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
| | - Gavin Marx
- Cancer Services, Sydney Adventist HospitalSydneyNew South WalesAustralia
- Northern Haematology and Oncology GroupSydney Adventist HospitalSydneyNew South WalesAustralia
- School of Medicine and PsychologyThe Australian National UniversityCanberraAustralia
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Peng DM, Li J, Qiu JX, Zhao L. Neoadjuvant pertuzumab plus trastuzumab in combination with chemotherapy for human epidermal growth factor receptor 2 positive breast cancer: a real-world retrospective single-institutional study in China. World J Surg Oncol 2024; 22:88. [PMID: 38582875 PMCID: PMC10998413 DOI: 10.1186/s12957-024-03365-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/28/2024] [Indexed: 04/08/2024] Open
Abstract
INTRODUCTION Real-world studies on neoadjuvant dual anti-HER2 therapy combined with chemotherapy for breast cancer (BC) are scarce in China. This study aimed to evaluate the efficacy and safety of neoadjuvant dual anti-HER2 therapy combined with chemotherapy in a real-world setting. Moreover, differences in estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and proliferation cell nuclear antigen (Ki-67) expression pre- and post-neoadjuvant therapy were analyzed. METHODS Clinical and pathological data of patients with HER2-positive BC who received neoadjuvant dual anti-HER2 therapy combined with chemotherapy at Liaoning Cancer Hospital & Institute, China, between September 2021 and September 2023, were retrospectively reviewed. RESULTS Among 179 included patients, a pathologic complete response (pCR) was achieved in 109 patients (60.9%). The univariate analysis results indicated that the hormone receptor (HR) status (P = 0.013), HER2 status (P = 0.003), and cycles of targeted treatment (P = 0.035) were significantly correlated with pCR. Subsequent multivariable analysis showed that HR negative and HER2 status 3 + were independent predictive factors of pCR. Anemia was the most common adverse event (62.0%), and the most common grade 3-4 adverse event was neutropenia (6.1%). The differences in HER2 (34.5%) and Ki-67 (92.7%) expression between core needle biopsy and the residual tumor after neoadjuvant therapy were statistically significant, whereas the differences were insignificant in terms of ER or PR status. CONCLUSIONS The combination of neoadjuvant trastuzumab and pertuzumab with chemotherapy showed good efficiency, and the toxic side effects were tolerable in patients with BC. In cases where pCR was not achieved after neoadjuvant therapy, downregulation of HER2 and Ki-67 expressions was observed.
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Affiliation(s)
- Dong-Mei Peng
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, NO, Shenyang, 110042, P.R. China
| | - Juan Li
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, NO, Shenyang, 110042, P.R. China
| | - Jia-Xin Qiu
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, NO, Shenyang, 110042, P.R. China
| | - Lin Zhao
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, 44 Xiaoheyan Road, NO, Shenyang, 110042, P.R. China.
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Bilici A, Olmez OF, Kaplan MA, Oksuzoglu B, Sezer A, Karadurmus N, Cubukcu E, Sendur MAN, Aksoy S, Erdem D, Basaran G, Cakar B, Shbair ATM, Arslan C, Sumbul AT, Sezgin Goksu S, Karadag I, Cicin I, Gumus M, Selcukbiricik F, Harputluoglu H, Demirci U. Impact of adding pertuzumab to trastuzumab plus chemotherapy in neoadjuvant treatment of HER2 positive breast cancer patients: a multicenter real-life HER2PATH study. Acta Oncol 2023; 62:381-390. [PMID: 37083566 DOI: 10.1080/0284186x.2023.2202330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
AIM To investigate the pathological complete response (pCR) achieved after neoadjuvant therapy with versus without adding pertuzumab (P) to trastuzumab (H) plus neoadjuvant chemotherapy (NCT) in HER2+ breast cancer (BC) patients in a real-life setting. METHODS A total of 1528 female HER2+ BC patients who received NCT plus H with or without P were included in this retrospective real-life study. Primary endpoint was pCR rate (ypT0/Tis ypN0). Clinicopathological characteristics, event-free survival (EFS) time, and relapse rates were evaluated with respect to HER2 blockade (NCT-H vs. NCT-HP) and pCR. RESULTS Overall, 62.2% of patients received NCT-H and 37.8% received NCT-HP. NCT-HP was associated with a significantly higher pCR rate (66.4 vs. 56.8%, p < 0.001) and lower relapse (4.5 vs. 12.2%, p < 0.001) in comparison to NCT-H. Patients with pCR had a significantly lower relapse (5.6 vs. 14.9%, p < 0.001) and longer EFS time (mean(SE) 111.2(1.9) vs. 93.9(2.7) months, p < 0.001) compared to patients with non-pCR. Patients in the NCT-HP group were more likely to receive docetaxel (75.0 vs. 40.6%, p < 0.001), while those with pCR were more likely to receive paclitaxel (50.2 vs. 40.7%, p < 0.001) and NCT-HP (41.5 vs. 32.1%, p < 0.001). Hormone receptor status and breast conservation rates were similar in NCT-HP vs. NCT-H groups and in patients with vs. without pCR. Invasive ductal carcinoma (OR, 2.669, 95% CI 1.596 to 4.464, p < 0.001), lower histological grade of the tumor (OR, 4.052, 95% CI 2.446 to 6.713, p < 0.001 for grade 2 and OR, 3.496, 95% CI 2.020 to 6.053, p < 0.001 for grade 3), lower T stage (OR, 1.959, 95% CI 1.411 to 2.720, p < 0.001) and paclitaxel (vs. docetaxel, OR, 1.571, 95% CI 1.127 to 2.190, p = 0.008) significantly predicted the pCR. CONCLUSIONS This real-life study indicates that adding P to NCT-H enables higher pCR than NCT-H in HER2+ BC, while pCR was associated with lower relapse and better EFS time.
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Affiliation(s)
- Ahmet Bilici
- Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Omer Fatih Olmez
- Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | | | - Berna Oksuzoglu
- University of Health Sciences Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Ahmet Sezer
- Baskent University Adana Hospital, Adana, Turkey
| | - Nuri Karadurmus
- University of Health Sciences Gulhane Training and Research Hospital, Ankara, Turkey
| | - Erdem Cubukcu
- Uludag University Faculty of Medicine, Bursa, Turkey
| | | | - Sercan Aksoy
- Hacettepe University Cancer Institute, Ankara, Turkey
| | - Dilek Erdem
- Samsun Medical Park Hospital, Samsun, Turkey
| | - Gul Basaran
- School of Medicine, Acibadem University, Istanbul, Turkey
| | - Burcu Cakar
- Ege University Faculty of Medicine, Izmir, Turkey
| | | | | | | | | | | | - Irfan Cicin
- Trakya University Faculty of Medicine, Edirne, Turkey
| | - Mahmut Gumus
- Istanbul Medeniyet University Faculty of Medicine, Istanbul, Turkey
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Real-world effectiveness of dual HER2 blockade with pertuzumab and trastuzumab for neoadjuvant treatment of HER2-positive early breast cancer (The NEOPETRA Study). Breast Cancer Res Treat 2020; 184:469-479. [PMID: 32876911 DOI: 10.1007/s10549-020-05866-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/06/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Neoadjuvant clinical trials with dual HER2 blockade with pertuzumab and trastuzumab plus chemotherapy demonstrated high rates of pathological complete response (pCR) in HER2-positive early breast cancer (BC). We investigated whether the benefit on pCR seen in clinical trials is confirmed in a real-world setting. METHODS Multicenter, retrospective study in patients with HER2-positive early BC receiving neoadjuvant treatment with pertuzumab and trastuzumab in routine clinical practice (n = 243). The primary endpoint was total pCR (tpCR) (ypT0/is ypN0). RESULTS A total of 243 evaluable patients were included. Pertuzumab and trastuzumab were combined with anthracyclines and taxanes in 74.1% of patients, with single-agent taxane in 11.1% of patients and with platinum-based chemotherapy (CT) in 14.4% of patients. The tpCR rate was 66.4%:71% with anthracyclines and taxanes, 59.3% with single-agent taxane, and 48.6% with platinum-based combinations. The tpCR rate was higher among patients with hormone receptor (HR)-negative tumors (80.9%) vs HR-positive tumors (55.4%) (p < 0.001). A pCR in the breast (ypT0/is) was achieved in 67.6% of patients. Of 143 patients who showed radiological complete response (rCR) (62%), 112 (78.3%) patients also achieved tpCR. Assessment of rCR by magnetic resonance imaging (MRI) showed the highest negative predictive value (NPV) for predicting tpCR (83.5%). Breast-conserving surgery was performed in 58.7% of patients. Grade 3 and grade 4 toxicities were reported in 33 (18.2%) and 12 (6.6%) patients, respectively. No toxicity leading to death was reported. CONCLUSIONS This real-world analysis shows that neoadjuvant pertuzumab, trastuzumab, and chemotherapy achieve comparable or even higher rates of tpCR than those seen in clinical trials. The pCR benefit is higher in HR-negative tumors. The assessment of rCR by MRI showed the highest ability for predicting pCR. In addition, this neoadjuvant strategy confers an acceptable safety profile.
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Goldner M, Franzoi MA, Lago LD, Pondé N. Anti-HER2 therapy for breast cancer in older patients. Future Oncol 2020; 16:1393-1407. [PMID: 32462916 DOI: 10.2217/fon-2020-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Older patients now form between 30 and 40% of breast cancer (BC) patients. Managing older patients with BC is particularly challenging due to the limited availability of high-quality evidence. In this review we discuss the available evidence on the efficacy and safety of anti-HER2 agents in older patients with HER2-positive BC is presented, with a particular look at the latest results of promising new agents such trastuzumab-deruxtecan. The data suggest that older patients can expect similar efficacy when using standard regimens, with higher toxicity, particular cardiac toxicity and diarrhea. Anti-HER2 agents should thus be used in most older patients most as per standard of care as long as adequate follow-up is available to manage toxicities.
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Affiliation(s)
- Marcelle Goldner
- Department of Clinical Oncology, AC Camargo Cancer Center, São Paulo 01509-010, Brazil
| | - Maria A Franzoi
- Clinical Trial Support Unit, Institut Jules Bordet Institute and L'Université Libre de Bruxelles, Brussels 1000, Belgium
| | - Lissandra D Lago
- Department of Medicine, Institut Jules Bordet Institute and L'Université Libre de Bruxelles, Brussels 1000, Belgium
| | - Noam Pondé
- Department of Clinical Oncology, AC Camargo Cancer Center, São Paulo 01509-010, Brazil
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