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. 2025 Feb 6:19:1840.
doi: 10.3332/ecancer.2025.1840. eCollection 2025.

Survival analysis of HER2 receptor negative and HER2 receptor low breast cancer patients at a Philippine Tertiary Government Hospital

Carl Arenos  1 , Steven Lim  2   1 , Andreu Lominoque  2   1 , Isabela Reveldez  2   1 , Angeli Sison-Dimaano  2   1 , Nehar Pagandaman  2   1 , Vincent Tatoy  2   1 , Timothy Uy  2   1 , Michael San Juan  2   1
Affiliations

Survival analysis of HER2 receptor negative and HER2 receptor low breast cancer patients at a Philippine Tertiary Government Hospital

Carl Arenos et al. Ecancermedicalscience. .

Abstract

Background and objectives: Human epidermal receptor 2 (HER2)-low breast cancer, characterised by specific immunohistochemistry (IHC) scores (+1 or +2) or negative fluorescence in-situ hybridiszation (FISH), has unique biological traits, therapeutic outcomes and prognosis. Recent studies highlight the effectiveness of Trastuzumab-Deruxtecan (T-Dxd) for HER2-low patients. This study seeks to deepen understanding of HER2 negative and low patients for tailored treatment by determining the 3-year disease-free survival (DFS) rates and prognostic variables of different subsets of HER2 negative (HER2 0) and HER2-low breast cancer patients (HER2 +1, HER2 +2 and HER2 FISH negative).

Methodology: We analysed the records of 138 patients with non-metastatic breast cancer, exhibiting HER2 IHC 0, +1 or +2/FISH negative. Data on 3-year DFS in months, age, stage (early stage versus locally advanced) and menopausal status were collected. Kaplan-Meier survival curves were used to plot 3-year DFS, while Cox Proportional Analysis assessed the prognostic significance of age and menopausal status in the HER2-low population.

Results: Three-year DFS for HER2 0 was 84.4%, HER2 +1 was 81.8% and HER2 +2/FISH negative was 52.9%, displaying statistically significant differences (p = 0.00012). Subgroup analyses revealed consistently worse DFS for HER2 +2/FISH negative patients in both early and advanced stages (p = 0.0042, 0.0057). Cox proportional analysis showed a recurrence hazard ratio of 4.0-4.5 for HER2 +2/FISH negative patients. Among prognostic factors, post-menopausal status correlated with a decreased risk of recurrence (HR 0.4387), signifying a 56.13% lower recurrence risk compared to pre-menopausal patients (p = 0.00723). On the other hand, patient age was not correlated with a reduced risk of recurrence (HR 0.97; p = 0.0544).

Conclusion: This study reveals a worse 3-year DFS in HER2 +2/FISH negative patients across both early and advanced disease stages. The findings highlight the prognostic importance of HER2-low status and may guide future therapeutic strategies, including the use of targeted therapies like T-Dxd in non-metastatic patients.

Keywords: Her2-low; breast cancer; prognosis.

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Conflict of interest statement

The authors do not declare any conflicts of interest in this study.

Figures

Figure 1.
Figure 1.. Study flow procedure.
Figure 2.
Figure 2.. DFS comparing TNBC and traditional HER2 negative patients.
Figure 3.
Figure 3.. DFS comparing TNBC with luminal HER2 0 and luminal HER2-low patients.
Figure 4.
Figure 4.. DFS comparing luminal HER2 0 with luminal HER2 +1 and luminal HER2 +2.
Figure 5.
Figure 5.. DFS in early stage breast cancer patients with HER2 0, HER2 +1 and HER2 +2/FISH negative status.
Figure 6.
Figure 6.. DFS in locally advanced breast cancer patients.
See this image and copyright information in PMC

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