Effectiveness of neoadjuvant trastuzumab and chemotherapy in HER2-overexpressing breast cancer

Clara Natoli, Patrizia Vici, Isabella Sperduti, Antonino Grassadonia, Giancarlo Bisagni, Nicola Tinari, Andrea Michelotti, Germano Zampa, Stefania Gori, Luca Moscetti, Michele De Tursi, Michele Panebianco, Maria Mauri, Ilaria Ferrarini, Laura Pizzuti, Corrado Ficorella, Riccardo Samaritani, Lucia Mentuccia, Stefano Iacobelli, Teresa Gamucci

Research output: Contribution to journalArticle

Abstract

Purpose: Trastuzumab and chemotherapy is the current standard of care in HER2+ early or locally advanced breast cancer, but there are scanty literature data of its real world effectiveness. Methods: We retrospectively reviewed 205 patients with HER2+ breast cancer diagnosed in 10 Italian Medical Oncology Units between July 2003 and October 2011. All patients received neoadjuvant systemic therapy (NST) with trastuzumab in association with chemotherapy. Many different chemotherapy regimens were used, even if 90 % of patients received schemes including anthracyclines and 99 % received taxanes. NST was administered for more than 21 weeks (median: 24) in 130/205 (63.4 %) patients, while trastuzumab was given for more than 12 weeks (median: 12 weeks) in 101/205 (49.3 %) patients. pCR/0 was defined as ypT0+ypN0, and pCR/is as ypT0/is+ypN0. Results: pCR/0 was obtained in 24.8 % and pCR/is in 46.8 % of the patients. At multivariate logistic regression, nonluminal/HER2+ tumors (P <0.0001) and more than 12 weeks of neoadjuvant trastuzumab treatment (P = 0.03) were independent predictors of pCR/0. Median disease-free survival (DFS) and cancer-specific survival (CSS) have not been reached at the time of analysis. At multivariate analysis, nonluminal/HER2+ subclass (DFS: P = 0.01 and CSS: P = 0.01) and pathological stage II-III at surgery (DFS: P <0.0001 and CSS: P = 0.001) were the only variables significantly associated with a worse long-term outcome. Conclusions: Our data set the relevance of molecular subclasses and residual tumor burden after neoadjuvant as the most relevant prognostic factors for survival in this cohort of patients.

Original languageEnglish
Pages (from-to)1229-1240
Number of pages12
JournalJournal of Cancer Research and Clinical Oncology
Volume139
Issue number7
DOIs
Publication statusPublished - Jul 2013

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Breast Neoplasms
Drug Therapy
Neoadjuvant Therapy
Disease-Free Survival
Survival
Neoplasms
Taxoids
Medical Oncology
Anthracyclines
Residual Neoplasm
Standard of Care
Trastuzumab
Tumor Burden
Multivariate Analysis
Logistic Models

Keywords

  • Breast cancer
  • HER2
  • Neoadjuvant
  • Pathological complete response
  • Survival
  • Trastuzumab

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Effectiveness of neoadjuvant trastuzumab and chemotherapy in HER2-overexpressing breast cancer. / Natoli, Clara; Vici, Patrizia; Sperduti, Isabella; Grassadonia, Antonino; Bisagni, Giancarlo; Tinari, Nicola; Michelotti, Andrea; Zampa, Germano; Gori, Stefania; Moscetti, Luca; De Tursi, Michele; Panebianco, Michele; Mauri, Maria; Ferrarini, Ilaria; Pizzuti, Laura; Ficorella, Corrado; Samaritani, Riccardo; Mentuccia, Lucia; Iacobelli, Stefano; Gamucci, Teresa.

In: Journal of Cancer Research and Clinical Oncology, Vol. 139, No. 7, 07.2013, p. 1229-1240.

Research output: Contribution to journalArticle

Natoli, C, Vici, P, Sperduti, I, Grassadonia, A, Bisagni, G, Tinari, N, Michelotti, A, Zampa, G, Gori, S, Moscetti, L, De Tursi, M, Panebianco, M, Mauri, M, Ferrarini, I, Pizzuti, L, Ficorella, C, Samaritani, R, Mentuccia, L, Iacobelli, S & Gamucci, T 2013, 'Effectiveness of neoadjuvant trastuzumab and chemotherapy in HER2-overexpressing breast cancer', Journal of Cancer Research and Clinical Oncology, vol. 139, no. 7, pp. 1229-1240. https://doi.org/10.1007/s00432-013-1436-y
Natoli, Clara ; Vici, Patrizia ; Sperduti, Isabella ; Grassadonia, Antonino ; Bisagni, Giancarlo ; Tinari, Nicola ; Michelotti, Andrea ; Zampa, Germano ; Gori, Stefania ; Moscetti, Luca ; De Tursi, Michele ; Panebianco, Michele ; Mauri, Maria ; Ferrarini, Ilaria ; Pizzuti, Laura ; Ficorella, Corrado ; Samaritani, Riccardo ; Mentuccia, Lucia ; Iacobelli, Stefano ; Gamucci, Teresa. / Effectiveness of neoadjuvant trastuzumab and chemotherapy in HER2-overexpressing breast cancer. In: Journal of Cancer Research and Clinical Oncology. 2013 ; Vol. 139, No. 7. pp. 1229-1240.
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AU - Natoli, Clara

AU - Vici, Patrizia

AU - Sperduti, Isabella

AU - Grassadonia, Antonino

AU - Bisagni, Giancarlo

AU - Tinari, Nicola

AU - Michelotti, Andrea

AU - Zampa, Germano

AU - Gori, Stefania

AU - Moscetti, Luca

AU - De Tursi, Michele

AU - Panebianco, Michele

AU - Mauri, Maria

AU - Ferrarini, Ilaria

AU - Pizzuti, Laura

AU - Ficorella, Corrado

AU - Samaritani, Riccardo

AU - Mentuccia, Lucia

AU - Iacobelli, Stefano

AU - Gamucci, Teresa

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N2 - Purpose: Trastuzumab and chemotherapy is the current standard of care in HER2+ early or locally advanced breast cancer, but there are scanty literature data of its real world effectiveness. Methods: We retrospectively reviewed 205 patients with HER2+ breast cancer diagnosed in 10 Italian Medical Oncology Units between July 2003 and October 2011. All patients received neoadjuvant systemic therapy (NST) with trastuzumab in association with chemotherapy. Many different chemotherapy regimens were used, even if 90 % of patients received schemes including anthracyclines and 99 % received taxanes. NST was administered for more than 21 weeks (median: 24) in 130/205 (63.4 %) patients, while trastuzumab was given for more than 12 weeks (median: 12 weeks) in 101/205 (49.3 %) patients. pCR/0 was defined as ypT0+ypN0, and pCR/is as ypT0/is+ypN0. Results: pCR/0 was obtained in 24.8 % and pCR/is in 46.8 % of the patients. At multivariate logistic regression, nonluminal/HER2+ tumors (P <0.0001) and more than 12 weeks of neoadjuvant trastuzumab treatment (P = 0.03) were independent predictors of pCR/0. Median disease-free survival (DFS) and cancer-specific survival (CSS) have not been reached at the time of analysis. At multivariate analysis, nonluminal/HER2+ subclass (DFS: P = 0.01 and CSS: P = 0.01) and pathological stage II-III at surgery (DFS: P <0.0001 and CSS: P = 0.001) were the only variables significantly associated with a worse long-term outcome. Conclusions: Our data set the relevance of molecular subclasses and residual tumor burden after neoadjuvant as the most relevant prognostic factors for survival in this cohort of patients.

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KW - Breast cancer

KW - HER2

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KW - Pathological complete response

KW - Survival

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