Efficacy of neoadjuvant treatment with or without pertuzumab in patients with stage II and III HER2-positive breast cancer: a nationwide cohort analysis of pathologic response and 5-year survival
Background: Pathologic complete response (pCR) rates in early stage HER2-positive breast cancer improved after pertuzumab was added to neoadjuvant treatment. However, survival benefit is less-well established and seems mostly limited to node-positive patients. We used national cancer registry data t...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-10-01
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| Series: | Breast |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0960977622001229 |
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| author | Anna van der Voort Marte C. Liefaard Mette S. van Ramshorst Erik van Werkhoven Joyce Sanders Jelle Wesseling Astrid Scholten Marie Jeanne T.F.D. Vrancken Peeters Linda de Munck Sabine Siesling Gabe S. Sonke |
| author_facet | Anna van der Voort Marte C. Liefaard Mette S. van Ramshorst Erik van Werkhoven Joyce Sanders Jelle Wesseling Astrid Scholten Marie Jeanne T.F.D. Vrancken Peeters Linda de Munck Sabine Siesling Gabe S. Sonke |
| author_sort | Anna van der Voort |
| collection | DOAJ |
| description | Background: Pathologic complete response (pCR) rates in early stage HER2-positive breast cancer improved after pertuzumab was added to neoadjuvant treatment. However, survival benefit is less-well established and seems mostly limited to node-positive patients. We used national cancer registry data to compare outcomes of patients treated with and without pertuzumab. Methods: We identified stage II-III HER2-positive breast cancer patients treated with neoadjuvant trastuzumab-based chemotherapy between November 2013 until January 2016 from the Netherlands Cancer Registry. During that period pertuzumab was only available in the 37 hospitals that participated in the TRAIN-2 study. Missing grade and pCR-status were obtained from the Dutch Pathology Registry (PALGA) and cause of death from Statistics Netherlands. We used multiple imputation to impute missing data, multivariable logistic regression to evaluate the association between pertuzumab and pCR (ypT0/is, ypN0) and multivariable Cox regression models for overall survival and breast cancer specific survival (BCSS). Results: We identified 1124 patients of whom 453 received pertuzumab. Baseline characteristics were comparable, although tumor grade was missing more often in patients treated without pertuzumab (12% vs. 2%). Pertuzumab improved pCR rates (41% vs 65%, adjusted odds ratio [aOR] 2.91; 95% CI:2.20–3.94). After a median follow-up of 6.0 years, 5-year BCSS rates were 95% and 98% respectively (adjusted hazard ratio [aHR]: 0.58; 95% CI:0.36–0.95). Younger patients derived more benefit from pertuzumab, but no other significant interactions were found. Conclusion: These results support earlier data of a small survival benefit with the addition of pertuzumab to trastuzumab-based neoadjuvant chemotherapy which is most meaningful in younger patients. |
| first_indexed | 2024-04-11T12:04:05Z |
| format | Article |
| id | doaj.art-8afd7b7a51b54354ada4317477a5ee96 |
| institution | Directory Open Access Journal |
| issn | 1532-3080 |
| language | English |
| last_indexed | 2024-04-11T12:04:05Z |
| publishDate | 2022-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Breast |
| spelling | doaj.art-8afd7b7a51b54354ada4317477a5ee962022-12-22T04:24:46ZengElsevierBreast1532-30802022-10-0165110115Efficacy of neoadjuvant treatment with or without pertuzumab in patients with stage II and III HER2-positive breast cancer: a nationwide cohort analysis of pathologic response and 5-year survivalAnna van der Voort0Marte C. Liefaard1Mette S. van Ramshorst2Erik van Werkhoven3Joyce Sanders4Jelle Wesseling5Astrid Scholten6Marie Jeanne T.F.D. Vrancken Peeters7Linda de Munck8Sabine Siesling9Gabe S. Sonke10Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the NetherlandsDepartment of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the NetherlandsDepartment of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the NetherlandsDepartment of Biometrics, Netherlands Cancer Institute, Amsterdam, the NetherlandsDepartment of Pathology, Netherlands Cancer Institute, Amsterdam, the NetherlandsDepartment of Pathology, Netherlands Cancer Institute, Amsterdam, the NetherlandsDepartment of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the NetherlandsDepartment of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; University of Amsterdam, the NetherlandsDepartment of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the NetherlandsDepartment of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands; Department of Health Technology and Services Research (HTSR), University of Twente, Enschede, the NetherlandsDepartment of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; University of Amsterdam, the Netherlands; Corresponding author. Department of Medical Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.Background: Pathologic complete response (pCR) rates in early stage HER2-positive breast cancer improved after pertuzumab was added to neoadjuvant treatment. However, survival benefit is less-well established and seems mostly limited to node-positive patients. We used national cancer registry data to compare outcomes of patients treated with and without pertuzumab. Methods: We identified stage II-III HER2-positive breast cancer patients treated with neoadjuvant trastuzumab-based chemotherapy between November 2013 until January 2016 from the Netherlands Cancer Registry. During that period pertuzumab was only available in the 37 hospitals that participated in the TRAIN-2 study. Missing grade and pCR-status were obtained from the Dutch Pathology Registry (PALGA) and cause of death from Statistics Netherlands. We used multiple imputation to impute missing data, multivariable logistic regression to evaluate the association between pertuzumab and pCR (ypT0/is, ypN0) and multivariable Cox regression models for overall survival and breast cancer specific survival (BCSS). Results: We identified 1124 patients of whom 453 received pertuzumab. Baseline characteristics were comparable, although tumor grade was missing more often in patients treated without pertuzumab (12% vs. 2%). Pertuzumab improved pCR rates (41% vs 65%, adjusted odds ratio [aOR] 2.91; 95% CI:2.20–3.94). After a median follow-up of 6.0 years, 5-year BCSS rates were 95% and 98% respectively (adjusted hazard ratio [aHR]: 0.58; 95% CI:0.36–0.95). Younger patients derived more benefit from pertuzumab, but no other significant interactions were found. Conclusion: These results support earlier data of a small survival benefit with the addition of pertuzumab to trastuzumab-based neoadjuvant chemotherapy which is most meaningful in younger patients.http://www.sciencedirect.com/science/article/pii/S0960977622001229Non-metastatic breast cancerHER2-PositiveErbB2PertuzumabNeoadjuvant chemotherapySurvival |
| spellingShingle | Anna van der Voort Marte C. Liefaard Mette S. van Ramshorst Erik van Werkhoven Joyce Sanders Jelle Wesseling Astrid Scholten Marie Jeanne T.F.D. Vrancken Peeters Linda de Munck Sabine Siesling Gabe S. Sonke Efficacy of neoadjuvant treatment with or without pertuzumab in patients with stage II and III HER2-positive breast cancer: a nationwide cohort analysis of pathologic response and 5-year survival Breast Non-metastatic breast cancer HER2-Positive ErbB2 Pertuzumab Neoadjuvant chemotherapy Survival |
| title | Efficacy of neoadjuvant treatment with or without pertuzumab in patients with stage II and III HER2-positive breast cancer: a nationwide cohort analysis of pathologic response and 5-year survival |
| title_full | Efficacy of neoadjuvant treatment with or without pertuzumab in patients with stage II and III HER2-positive breast cancer: a nationwide cohort analysis of pathologic response and 5-year survival |
| title_fullStr | Efficacy of neoadjuvant treatment with or without pertuzumab in patients with stage II and III HER2-positive breast cancer: a nationwide cohort analysis of pathologic response and 5-year survival |
| title_full_unstemmed | Efficacy of neoadjuvant treatment with or without pertuzumab in patients with stage II and III HER2-positive breast cancer: a nationwide cohort analysis of pathologic response and 5-year survival |
| title_short | Efficacy of neoadjuvant treatment with or without pertuzumab in patients with stage II and III HER2-positive breast cancer: a nationwide cohort analysis of pathologic response and 5-year survival |
| title_sort | efficacy of neoadjuvant treatment with or without pertuzumab in patients with stage ii and iii her2 positive breast cancer a nationwide cohort analysis of pathologic response and 5 year survival |
| topic | Non-metastatic breast cancer HER2-Positive ErbB2 Pertuzumab Neoadjuvant chemotherapy Survival |
| url | http://www.sciencedirect.com/science/article/pii/S0960977622001229 |
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