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Irelli A, Parisi A, D’Orazio C, Sidoni T, Rotondaro S, Patruno L, Pavese F, Bafile A, Resta V, Pizzorno L, Ciuffetelli V, Dal Mas A, Calvisi G, Di Sibio A, Marzullo A, Zelli V, Compagnoni C, Tessitore A, Alesse E, Ficorella C, Cortellini A, Cannita K. Anthracycline-Free Neoadjuvant Treatment in Patients with HER2-Positive Breast Cancer: Real-Life Use of Pertuzumab, Trastuzumab and Taxanes Association with an Exploratory Analysis of PIK3CA Mutational Status. Cancers (Basel) 2022; 14:3003. [PMID: 35740668 PMCID: PMC9220864 DOI: 10.3390/cancers14123003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 12/04/2022] Open
Abstract
HER2 is considered one of the most traditional prognostic and predictive biomarkers in breast cancer. Literature data confirmed that the addition of pertuzumab to a standard neoadjuvant chemotherapy backbone (either with or without anthracyclines), in patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer (EBC), leads to a higher pathological complete response (pCR) rate, which is known to correlate with a better prognosis. In this retrospective analysis, 47 consecutive patients with HER2-positive EBC received sequential anthracyclines and taxanes plus trastuzumab (ATH) or pertuzumab, trastuzumab and docetaxel (THP). Despite the limited sample size, this monocentric experience highlights the efficacy (in terms of pCR) and safety of THP in the neoadjuvant setting of HER2-positive EBC as an anthracycline-free approach. Given the role of PIK3CA as a prognostic and therapeutic target in breast cancer, tumors were also analyzed to assess the PIK3CA mutational status. Thirty-eight out of forty-seven patients were evaluated, and PIK3CA variants were identified in 21% of tumor samples: overall, one mutation was detected in exon 4 (2.6%), two in exon 9 (5.3%) and four in exon 20 (10.5%). Of note, one sample showed concurrent mutations in exons 9 (codon 545) and 20 (codon 1047). Among patients reaching pCR (n = 13), 38.5% were PIK3CA mutants; on the other hand, among those lacking pCR (n = 25), just 12% showed PIK3CA variants. Regarding THP-treated mutant patients (n = 5), 80% reached pCR (three hormone-receptor-negative, one hormone-receptor-positive). Interestingly, the only patient not achieving pCR had a tumor with two co-occurring PIK3CA mutations. In conclusion, this study provides new evidence about the efficacy and good safety profile of THP, compared to the ATH regimen, as an anthracycline-free neoadjuvant treatment of HER2-positive EBC. Further studies on larger/multicentric cohorts are planned for more in-depth analysis to confirm our molecular and clinical results.
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Affiliation(s)
- Azzurra Irelli
- Medical Oncology Unit, Department of Oncology, AUSL 04 Teramo, 64100 Teramo, Italy;
| | - Alessandro Parisi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
- Department of Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, 60126 Ancona, Italy
| | - Carla D’Orazio
- Medical Oncology, St. Salvatore Hospital, 67100 L’Aquila, Italy; (C.D.); (T.S.); (S.R.); (L.P.); (F.P.); (C.F.)
| | - Tina Sidoni
- Medical Oncology, St. Salvatore Hospital, 67100 L’Aquila, Italy; (C.D.); (T.S.); (S.R.); (L.P.); (F.P.); (C.F.)
| | - Silvia Rotondaro
- Medical Oncology, St. Salvatore Hospital, 67100 L’Aquila, Italy; (C.D.); (T.S.); (S.R.); (L.P.); (F.P.); (C.F.)
| | - Leonardo Patruno
- Medical Oncology, St. Salvatore Hospital, 67100 L’Aquila, Italy; (C.D.); (T.S.); (S.R.); (L.P.); (F.P.); (C.F.)
| | - Francesco Pavese
- Medical Oncology, St. Salvatore Hospital, 67100 L’Aquila, Italy; (C.D.); (T.S.); (S.R.); (L.P.); (F.P.); (C.F.)
| | - Alberto Bafile
- Breast Unit, St. Salvatore Hospital, 67100 L’Aquila, Italy; (A.B.); (V.R.); (L.P.)
| | - Valter Resta
- Breast Unit, St. Salvatore Hospital, 67100 L’Aquila, Italy; (A.B.); (V.R.); (L.P.)
| | - Laura Pizzorno
- Breast Unit, St. Salvatore Hospital, 67100 L’Aquila, Italy; (A.B.); (V.R.); (L.P.)
| | - Virginia Ciuffetelli
- Pathology Unit, St. Salvatore Hospital, 67100 L’Aquila, Italy; (V.C.); (A.D.M.); (G.C.)
| | - Antonella Dal Mas
- Pathology Unit, St. Salvatore Hospital, 67100 L’Aquila, Italy; (V.C.); (A.D.M.); (G.C.)
| | - Giuseppe Calvisi
- Pathology Unit, St. Salvatore Hospital, 67100 L’Aquila, Italy; (V.C.); (A.D.M.); (G.C.)
| | | | - Anna Marzullo
- Nuclear Medicine Unit, St. Salvatore Hospital, 67100 L’Aquila, Italy;
| | - Veronica Zelli
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 L’Aquila, Italy; (V.Z.); (C.C.); (A.T.); (E.A.)
| | - Chiara Compagnoni
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 L’Aquila, Italy; (V.Z.); (C.C.); (A.T.); (E.A.)
| | - Alessandra Tessitore
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 L’Aquila, Italy; (V.Z.); (C.C.); (A.T.); (E.A.)
| | - Edoardo Alesse
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Via Vetoio, 67100 L’Aquila, Italy; (V.Z.); (C.C.); (A.T.); (E.A.)
| | - Corrado Ficorella
- Medical Oncology, St. Salvatore Hospital, 67100 L’Aquila, Italy; (C.D.); (T.S.); (S.R.); (L.P.); (F.P.); (C.F.)
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK;
| | - Katia Cannita
- Medical Oncology Unit, Department of Oncology, AUSL 04 Teramo, 64100 Teramo, Italy;
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Stoen E, Kagihara J, Shagisultanova E, Fisher CM, Nicklawsky A, Kabos P, Borges VF, Diamond JR. Real-world evidence from a University Hospital system regarding the uptake of adjuvant pertuzumab and/or neratinib before and after their FDA approval. Breast Cancer Res Treat 2021; 187:883-891. [PMID: 33625615 PMCID: PMC8197701 DOI: 10.1007/s10549-021-06132-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/05/2021] [Indexed: 11/20/2022]
Abstract
Purpose Adjuvant pertuzumab and neratinib are independently FDA-approved for treatment of early-stage HER2-positive breast cancer in combination with or following trastuzumab for one year, respectively. Both agents reduce the risk of recurrence; however, the absolute benefit is modest for many patients with added risk of adverse effects. The purpose of this study was to evaluate the clinical use of adjuvant pertuzumab and neratinib in patients with early-stage HER2-positive breast cancer. Methods Patients diagnosed with stage I–III HER2-positive breast cancer treated with trastuzumab at four University of Colorado Health hospitals between July 2016 and April 2019 were identified. Patient demographics, cancer stage, treatment, and administration of pertuzumab and/or neratinib were obtained. Results We identified a total of 350 patients who received adjuvant trastuzumab for stage I–III HER2-positive breast cancer; 253 (73.1%) had tumors that were ≥ T2 or node-positive disease. The rate of adjuvant pertuzumab use increased following FDA approval; pertuzumab was administered to the majority of patients with node-positive HER2-positive breast cancer. The use of adjuvant pertuzumab was associated with younger age, premenopausal status, and node-positive disease. Rates of administration of adjuvant neratinib were lower, with only 15.2% of patients receiving this therapy within 3 months of completing adjuvant trastuzumab. Conclusion In our cohort of patients treated within a diverse healthcare network, the majority of patients with node-positive HER2-positive breast cancer received adjuvant pertuzumab following FDA approval. The use of adjuvant neratinib was less common, potentially as a result of adverse effects, prolongation of therapy, previous administration of adjuvant pertuzumab, and modest benefit.
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Affiliation(s)
- Ericson Stoen
- Department of Internal Medicine, University of Colorado School of Medicine, 12401 East 17th Avenue, Mailstop F-782, Aurora, CO, 80045, USA.
| | - Jodi Kagihara
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elena Shagisultanova
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christine M Fisher
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Andrew Nicklawsky
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Peter Kabos
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Virginia F Borges
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer R Diamond
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
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