Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 110-115 |
| Number of pages | 6 |
| Journal | Breast |
| Volume | 65 |
| DOIs | |
| Publication status | Published - Oct 2022 |
| Externally published | Yes |
Bibliographical note
Funding Information:This research was funded by a donation from the Team Westland foundation (to GSS). Team Westland played no role in the design or execution of this study, nor in the execution of the analysis, interpretation of data, writing the manuscript or in the decision to submit for publication.
Funding Information:
This research was funded by a donation from the Team Westland foundation (to GSS). Team Westland played no role in the design or execution of this study, nor in the execution of the analysis, interpretation of data, writing the manuscript or in the decision to submit for publication.We thank the staff and data managers of the Netherlands Comprehensive Cancer Organization (IKNL), Statistics Netherlands (CBS), the nationwide network and registry of histo- and cytopathology in the Netherlands (PALGA), and the staff of the core facility molecular pathology and biobanking (CFMPB) of the Netherlands Cancer Institute for the collection of the data and support during data analyses. We thank the Dutch Breast Cancer Research Group (BOOG) as the study sponsor and Roche as the funder of the investigator-initiated TRAIN-2 study for making pertuzumab available for study patients.
Publisher Copyright:
© 2022 The Author(s)
