Pathologic response and survival after neoadjuvant chemotherapy with or without pertuzumab in patients with HER2-positive breast cancer: the Neopearl nationwide collaborative study
PurposeClinical trials have shown a significant increase in pathologic complete response (pCR) with the addition of pertuzumab to neoadjuvant chemotherapy for patients with early-stage HER-2 positive breast cancer. To date, limited studies have examined comparative outcomes of neoadjuvant pertuzumab...
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| Format: | Article |
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Frontiers Media S.A.
2023-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1177681/full |
| _version_ | 1797794205382213632 |
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| author | Agnese Fabbri Fabrizio Nelli Andrea Botticelli Diana Giannarelli Eleonora Marrucci Cristina Fiore Antonella Virtuoso Simone Scagnoli Simona Pisegna Daniele Alesini Valentina Sini Armando Orlandi Alessandra Fabi Federico Piacentini Luca Moscetti Giuliana D’Auria Teresa Gamucci Marco Mazzotta Laura Pizzuti Patrizia Vici Elisabetta Cretella Paola Scavina Annalisa La Cesa Mara Persano Francesco Atzori Enzo Maria Ruggeri |
| author_facet | Agnese Fabbri Fabrizio Nelli Andrea Botticelli Diana Giannarelli Eleonora Marrucci Cristina Fiore Antonella Virtuoso Simone Scagnoli Simona Pisegna Daniele Alesini Valentina Sini Armando Orlandi Alessandra Fabi Federico Piacentini Luca Moscetti Giuliana D’Auria Teresa Gamucci Marco Mazzotta Laura Pizzuti Patrizia Vici Elisabetta Cretella Paola Scavina Annalisa La Cesa Mara Persano Francesco Atzori Enzo Maria Ruggeri |
| author_sort | Agnese Fabbri |
| collection | DOAJ |
| description | PurposeClinical trials have shown a significant increase in pathologic complete response (pCR) with the addition of pertuzumab to neoadjuvant chemotherapy for patients with early-stage HER-2 positive breast cancer. To date, limited studies have examined comparative outcomes of neoadjuvant pertuzumab in real-world setting. The Neopearl study aimed to assess comparative real-life efficacy and safety of neoadjuvant pertuzumab for these patients.MethodsWe conducted a nationwide retrospective analysis involving 17 oncology facilities with a certified multidisciplinary breast cancer treatment committee. We identified patients with HER-2 positive stage II-III breast cancer treated with neoadjuvant chemotherapy based on trastuzumab and taxanes with or without pertuzumab. All patients underwent breast surgery and received a comprehensive cardiologic evaluation at baseline and after neoadjuvant treatment. Patients who received the combination of pertuzumab, trastuzumab, and chemotherapy constituted case cohort (PTCT), whereas those treated with trastuzumab and chemotherapy accounted for control cohort (TCT). The pCR rate and 5-year event free survival (EFS) were the primary outcomes. Secondary end-points were rates of conversion from planned modified radical mastectomy (MRM) to breast conservation surgery (BCS) and cardiotoxicities.ResultsFrom March 2014 to April 2021, we included 271 patients, 134 (49%) and 137 (51%) in TCT and PTCT cohort, respectively. Positive axillary lymph nodes and stage III were more frequent in PTCT cohort. The pCR rate was significantly increased in patients who received pertuzumab (49% vs 62%; OR 1.74, 95%CI 1.04-2.89) and with HER-2 enriched subtypes (16% vs 85%; OR 2.94, 95%CI 1.60-5.41). After a median follow-up of 5 years, the 5-year EFS was significantly prolonged only in patients treated with pertuzumab (81% vs 93%; HR 2.22, 95%CI 1.03-4.79). The same analysis performed on propensity score matched population showed concordant results. On univariate analysis, only patients with positive lymph nodes were found to benefit from pertuzumab for both pCR and 5-year EFS. The rates of conversion from MRM to BCS and cardiologic toxicities did not differ between the cohorts.ConclusionOur findings support previous data on improved outcomes with the addition of pertuzumab to trastuzumab-based neoadjuvant chemotherapy. This benefit seems to be more significant in patients with clinically positive lymph nodes. |
| first_indexed | 2024-03-13T02:59:25Z |
| format | Article |
| id | doaj.art-26649e667aa0456fbd64724a36c65d33 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-13T02:59:25Z |
| publishDate | 2023-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-26649e667aa0456fbd64724a36c65d332023-06-27T16:07:31ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-06-011310.3389/fonc.2023.11776811177681Pathologic response and survival after neoadjuvant chemotherapy with or without pertuzumab in patients with HER2-positive breast cancer: the Neopearl nationwide collaborative studyAgnese Fabbri0Fabrizio Nelli1Andrea Botticelli2Diana Giannarelli3Eleonora Marrucci4Cristina Fiore5Antonella Virtuoso6Simone Scagnoli7Simona Pisegna8Daniele Alesini9Valentina Sini10Armando Orlandi11Alessandra Fabi12Federico Piacentini13Luca Moscetti14Giuliana D’Auria15Teresa Gamucci16Marco Mazzotta17Laura Pizzuti18Patrizia Vici19Elisabetta Cretella20Paola Scavina21Annalisa La Cesa22Mara Persano23Francesco Atzori24Enzo Maria Ruggeri25Department of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, ItalyDepartment of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, ItalyDepartment of Radiological, Oncological and Pathological Science, Sapienza University of Rome, Rome, ItalyBiostatistics Unit, Scientific Directorate, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, ItalyDepartment of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, ItalyDepartment of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, ItalyDepartment of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, ItalyDepartment of Radiological, Oncological and Pathological Science, Sapienza University of Rome, Rome, ItalyDepartment of Radiological, Oncological and Pathological Science, Sapienza University of Rome, Rome, ItalyUOSD Centro Oncologico S. Spirito e Nuovo Regina Margherita (SS-NRM), Ospedale Santo Spirito in Sassia, Rome, ItalyUOSD Centro Oncologico S. Spirito e Nuovo Regina Margherita (SS-NRM), Ospedale Santo Spirito in Sassia, Rome, ItalyDepartment of Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalyPrecision Medicine Breast Unit, Scientific Directorate, Department of Women, Children and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, ItalyDepartment of Medical Oncology, University Hospital of Modena, Modena, ItalyDepartment of Medical Oncology, University Hospital of Modena, Modena, ItalyDepartment of Medical Oncology, Medical Oncology Unit, Sandro Pertini Hospital, Rome, ItalyDepartment of Medical Oncology, Medical Oncology Unit, Sandro Pertini Hospital, Rome, ItalyDepartment of Medical Oncology, Medical Oncology Unit, Sandro Pertini Hospital, Rome, ItalyUOSD Sperimentazioni di fase IV, IRCCS Regina Elena National Cancer Institute, Rome, ItalyUOSD Sperimentazioni di fase IV, IRCCS Regina Elena National Cancer Institute, Rome, Italy0Department of Medical Oncology, Medical Oncology Unit, Ospedale Di Bolzano, Azienda Sanitaria Alto Adige, Bolzano, Italy1Department of Medical Oncology, Medical Oncology Unit, San Giovanni Addolorata Hospital, Rome, Italy2Department of Medical Oncology, Campus Bio-Medico University, Rome, Italy3Department of Medical Oncology, University Hospital and University of Cagliari, Cagliari, Italy3Department of Medical Oncology, University Hospital and University of Cagliari, Cagliari, ItalyDepartment of Oncology and Hematology, Medical Oncology and Breast Unit, Central Hospital of Belcolle, Viterbo, ItalyPurposeClinical trials have shown a significant increase in pathologic complete response (pCR) with the addition of pertuzumab to neoadjuvant chemotherapy for patients with early-stage HER-2 positive breast cancer. To date, limited studies have examined comparative outcomes of neoadjuvant pertuzumab in real-world setting. The Neopearl study aimed to assess comparative real-life efficacy and safety of neoadjuvant pertuzumab for these patients.MethodsWe conducted a nationwide retrospective analysis involving 17 oncology facilities with a certified multidisciplinary breast cancer treatment committee. We identified patients with HER-2 positive stage II-III breast cancer treated with neoadjuvant chemotherapy based on trastuzumab and taxanes with or without pertuzumab. All patients underwent breast surgery and received a comprehensive cardiologic evaluation at baseline and after neoadjuvant treatment. Patients who received the combination of pertuzumab, trastuzumab, and chemotherapy constituted case cohort (PTCT), whereas those treated with trastuzumab and chemotherapy accounted for control cohort (TCT). The pCR rate and 5-year event free survival (EFS) were the primary outcomes. Secondary end-points were rates of conversion from planned modified radical mastectomy (MRM) to breast conservation surgery (BCS) and cardiotoxicities.ResultsFrom March 2014 to April 2021, we included 271 patients, 134 (49%) and 137 (51%) in TCT and PTCT cohort, respectively. Positive axillary lymph nodes and stage III were more frequent in PTCT cohort. The pCR rate was significantly increased in patients who received pertuzumab (49% vs 62%; OR 1.74, 95%CI 1.04-2.89) and with HER-2 enriched subtypes (16% vs 85%; OR 2.94, 95%CI 1.60-5.41). After a median follow-up of 5 years, the 5-year EFS was significantly prolonged only in patients treated with pertuzumab (81% vs 93%; HR 2.22, 95%CI 1.03-4.79). The same analysis performed on propensity score matched population showed concordant results. On univariate analysis, only patients with positive lymph nodes were found to benefit from pertuzumab for both pCR and 5-year EFS. The rates of conversion from MRM to BCS and cardiologic toxicities did not differ between the cohorts.ConclusionOur findings support previous data on improved outcomes with the addition of pertuzumab to trastuzumab-based neoadjuvant chemotherapy. This benefit seems to be more significant in patients with clinically positive lymph nodes.https://www.frontiersin.org/articles/10.3389/fonc.2023.1177681/fullpertuzumabtrastuzumabbreast cancerneoadjuvant chemotherapyHER-2 positivereal-world data |
| spellingShingle | Agnese Fabbri Fabrizio Nelli Andrea Botticelli Diana Giannarelli Eleonora Marrucci Cristina Fiore Antonella Virtuoso Simone Scagnoli Simona Pisegna Daniele Alesini Valentina Sini Armando Orlandi Alessandra Fabi Federico Piacentini Luca Moscetti Giuliana D’Auria Teresa Gamucci Marco Mazzotta Laura Pizzuti Patrizia Vici Elisabetta Cretella Paola Scavina Annalisa La Cesa Mara Persano Francesco Atzori Enzo Maria Ruggeri Pathologic response and survival after neoadjuvant chemotherapy with or without pertuzumab in patients with HER2-positive breast cancer: the Neopearl nationwide collaborative study Frontiers in Oncology pertuzumab trastuzumab breast cancer neoadjuvant chemotherapy HER-2 positive real-world data |
| title | Pathologic response and survival after neoadjuvant chemotherapy with or without pertuzumab in patients with HER2-positive breast cancer: the Neopearl nationwide collaborative study |
| title_full | Pathologic response and survival after neoadjuvant chemotherapy with or without pertuzumab in patients with HER2-positive breast cancer: the Neopearl nationwide collaborative study |
| title_fullStr | Pathologic response and survival after neoadjuvant chemotherapy with or without pertuzumab in patients with HER2-positive breast cancer: the Neopearl nationwide collaborative study |
| title_full_unstemmed | Pathologic response and survival after neoadjuvant chemotherapy with or without pertuzumab in patients with HER2-positive breast cancer: the Neopearl nationwide collaborative study |
| title_short | Pathologic response and survival after neoadjuvant chemotherapy with or without pertuzumab in patients with HER2-positive breast cancer: the Neopearl nationwide collaborative study |
| title_sort | pathologic response and survival after neoadjuvant chemotherapy with or without pertuzumab in patients with her2 positive breast cancer the neopearl nationwide collaborative study |
| topic | pertuzumab trastuzumab breast cancer neoadjuvant chemotherapy HER-2 positive real-world data |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1177681/full |
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