Risk of Recurrence and Death in Patients with Early HER2+ Breast Cancer Who Achieve a Pathologic Complete Response After Different Types of HER2-Targeted Therapy

The current standard of care for patients achieving a pathologic complete response (pCR) after HER2-targeted therapy plus chemotherapy in the neoadjuvant setting is to continue HER2-targeted therapy in the adjuvant setting. The aim of the exploratory data analysis presented at SABCS 2019 was to report the risk of recurrence and death after neoadjuvant systemic therapy in neoadjuvant trials in patients with HER2+ early breast cancer who achieved a pCR.1 Data from the HannaH, NeoSphere, TRYPHAENA, BERENICE, and KRISTINE studies were pooled. Neoadjuvant followed by adjuvant therapeutic regimens analyzed were trastuzumab followed by trastuzumab (H→H), pertuzumab plus trastuzumab followed by trastuzumab (PH→H), and pertuzumab plus trastuzumab followed by pertuzumab plus trastuzumab (PH→PH).

pCR was defined as the absence of residual invasive cancer in the resected breast specimen and in the axillary lymph nodes after neoadjuvant systemic therapy. Event-free survival (EFS) was defined as the time from the date of randomization to the date of disease recurrence or progression (local, regional, distant, or contralateral) or death due to any cause.

A total of 1764 patients were included in the analysis. Overall, patients with a pCR had an increased EFS probability compared with those with residual disease (unadjusted hazard ratio, 0.33; 95% confidence interval [CI], 0.25-0.43), and this was maintained in patients stratified by hormone receptor status and disease stage. The 3-year EFS rates in patients who achieved a pCR were 87% (95% CI, 82%-90%) in the H→H group, 92% (95% CI, 87%-95%) in the PH→H group, and 95% (95% CI, 90%-97%) in the PH→PH group.

The authors concluded that patients who attained a pCR have a better long-term outcome compared with those with residual disease, regardless of estrogen receptor status or clinical stage. However, some patients who achieved a pCR still had a risk of relapse.

Reference

1. Swain SM, et al. SABCS 2019. Abstract P1-18-01.

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