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. 2023 Jan 24:12:1022994.
doi: 10.3389/fonc.2022.1022994. eCollection 2022.

Real-life analysis of neoadjuvant-therapy-associated benefits for pathological complete response and survival in early breast cancer patients - role of trastuzumab in HER2+ BC and platinum in TNBC

Wei-Pang Chung  1   2 , Chun-Ting Yang  3 , Shuen-Ru Yang  1 , Ching-Yen Su  4 , Hsin-Wei Su  4 , Shang-Yun Liu  4 , Huang-Tz Ou  3   5
Affiliations

Real-life analysis of neoadjuvant-therapy-associated benefits for pathological complete response and survival in early breast cancer patients - role of trastuzumab in HER2+ BC and platinum in TNBC

Wei-Pang Chung et al. Front Oncol. .

Abstract

Background: Neoadjuvant therapy, which aims to achieve a pathological complete response (pCR) for better overall survival (OS) has several advantages for patients with early breast cancer (eBC) and subtypes of HER2-positive (HER2+) and triple-negative breast cancer (TNBC). However, there has been no large-scale real-world investigation on the clinical outcomes associated with trastuzumab-based and platinum-based neoadjuvant treatments for patients with HER2+ and TNBC, respectively.

Material and methods: Taiwan Cancer Registry and National Health Insurance Research Database were utilized in this study. Patients diagnosed with clinically lymph-node-positive (LN+) HER2+ or TNBC were identified for analysis. Logistic regression and Cox proportional hazard models were employed to estimate the adjusted odds ratios (aOR) of achieving pCR and adjusted hazard ratios (aHR) of overall survival associated with treatment agents, respectively.

Results: A total of 1,178 HER2+ eBC and 354 early TNBC patients were identified, respectively. Neoadjuvant trastuzumab significantly increased the pCR rates by 3.87-fold among HER2+ patients. Trastuzumab-associated survival benefit was found in HER2+ patients who achieved pCR (aHR [95% CI]: 0.30 [0.11-0.84]) but not in those without pCR (1.13 [0.77-1.67]). Among the TNBC patients, platinum was associated with a 1.6-fold increased pCR rate; however, it did not improve OS regardless of pCR status.

Conclusions: Trastuzumab improved pCR and OS for patients with HER2+ subtype. Using platinum agents for TNBC patients increased pCR rates but was not linked to better survival. Optimal neoadjuvant anti-HER2 therapy for patients with HER2+ eBC and the introduction of novel therapy for patients with TNBC should be considered.

Keywords: HER2-positive breast cancer; early breast cancer; neoadjuvant therapy; platinum; trastuzumab; triple-negative breast cancer.

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Conflict of interest statement

C-YS, H-WS, and S-YL are employees of Roche Products Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of cohort selection. eBC, early breast cancer; BC, breast cancer; pCR, pathological complete response; HR, hormone receptor; HER2, human epidermal growth factor receptor-2; TNBC, triple-negative breast cancer; LN+, lymph-node positive. *The characteristics included the clinical staging of BC, subtype of BC (i.e., HR+ & HER2-, HER2+, and TNBC), diagnosis date of BC, and the eligibility of receiving neoadjuvant therapy (i.e., clinical N or T staging as the eligibility of receiving neoadjuvant therapy).
Figure 2
Figure 2
Adoption rates of receiving neoadjuvant therapy during 2011-2016 among eBC patients with clinically positive lymph-node status. p refers to the p-value for a time trend; a p-value of less than 0.05 indicates a significant change of adoption rates of neoadjuvant therapy over time. eBC, early breast cancer; BC, breast cancer; pCR, pathological complete response; HR, hormone receptor; HER2, human epidermal growth factor receptor-2; TNBC, triple-negative breast cancer; LN+, lymph-node positive.
Figure 3
Figure 3
KM curves of OS stratified by status of pCR in overall study population. KM, Kaplan-Meier; OS, overall survival; pCR, pathological complete response; HR, hazard ratio.
Figure 4
Figure 4
KM curves of OS stratified by status of pCR and subtype. KM, Kaplan-Meier; OS, overall survival; pCR, pathological complete response; HR, hazard ratio; HER2, human epidermal growth factor receptor-2; TNBC, triple-negative breast cancer.
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References

    1. Korde LA, Somerfield MR, Carey LA, Crews JR, Denduluri N, Hwang ES, et al. . Neoadjuvant chemotherapy, endocrine therapy, and targeted therapy for breast cancer: ASCO guideline. J Clin Oncol (2021) 39(13):1485–505. doi: 10.1200/JCO.20.03399 - DOI - PMC - PubMed
    1. Cortazar P, Zhang L, Untch M, Mehta K, Costantino JP, Wolmark N, et al. . Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet (2014) 384(9938):164–72. doi: 10.1016/S0140-6736(13)62422-8 - DOI - PubMed
    1. Spring LM, Fell G, Arfe A, Sharma C, Greenup R, Reynolds KL, et al. . Pathologic complete response after neoadjuvant chemotherapy and impact on breast cancer recurrence and survival: A comprehensive meta-analysis. Clin Cancer Res (2020) 26(12):2838–48. doi: 10.1158/1078-0432.CCR-19-3492 - DOI - PMC - PubMed
    1. Huang M, O'Shaughnessy J, Zhao J, Haiderali A, Cortés J, Ramsey SD, et al. . Association of pathologic complete response with long-term survival outcomes in triple-negative breast cancer: A meta-analysis. Cancer Res (2020) 80(24):5427–34. doi: 10.1158/0008-5472.CAN-20-1792 - DOI - PubMed
    1. Buzdar AU, Ibrahim NK, Francis D, Booser DJ, Thomas ES, Theriault RL, et al. . Significantly higher pathologic complete remission rate after neoadjuvant therapy with trastuzumab, paclitaxel, and epirubicin chemotherapy: results of a randomized trial in human epidermal growth factor receptor 2-positive operable breast cancer. J Clin Oncol (2005) 23(16):3676–85. doi: 10.1200/JCO.2005.07.032 - DOI - PubMed