"Triple positive" early breast cancer: An observational multicenter retrospective analysis of outcome

Patrizia Vici, Laura Pizzuti, Isabella Sperduti, A. Frassoldati, C. Natoli, T. Gamucci, Silverio Tomao, A. Michelotti, Luca Moscetti, Stefania Gori, E. Baldini, Francesco Giotta, Alessandra Cassano, Daniele Santini, Diana Giannarelli, Luigi Di Lauro, D. Corsi, Paolo Marchetti, Valentina Sini, Domenico SergiMaddalena Barba, Marcello Maugeri-Saccà, Michelangelo Russillo, Lucia Mentuccia, Loretta D'Onofrio, Laura Iezzi, A. F. Scinto, Lucia Da Ros, Ilaria Bertolini, M. L. Basile, Valentina Rossi, Ruggero Marchiano De Maria, Filippo Montemurro

Research output: Contribution to journalArticlepeer-review


We recently found that trastuzumab benefit may be lower in a small subset of early breast cancer (BC) patients (pts) with tumors expressing high levels of both hormonal receptors (HRs), i.e. triple positive (TP). To better investigate the role of HRs in HER2 positive BC, we retrospectively identified 872 TP BC pts treated with adjuvant chemotherapy alone (cohort A-366 pts), or plus trastuzumab (cohort B-506 pts). Relapse-free-survival (RFS) and breast-cancer-specific-survival (BCSS) were evaluated. Trastuzumab improved RFS and BCSS in all the subsets analyzed, but the effect on BCSS in tumors expressing both HRs in >30% of cells (TP30), and even on RFS in tumors with both HRs expressed in >50% of cells (TP50) was not significant. Distinct patterns of relapse were observed in TP50 and no-TP50 tumors, the former showing low and constant risk in the first 5 years, a late increase beyond 5 years and modest trastuzumab effect. Trastuzumab effect tended to disappear in pts whose tumors expressed ER in >50% of cells. Multivariate analysis of RFS confirmed a significant interaction between trastuzumab and ER expression, with benefit confined to pts whose tumors expressed ER in ≤50% of cells. Our data suggest that the pattern of relapse of TP tumors with high HRs is similar to that of "luminal", HER2 negative tumors, without clear benefit from adjuvant trastuzumab, which remains the standard treatment even in TP tumors. Confirmatory findings on the extent to which quantitative expression of HRs may impact clinical behavior of HER2 positive BC are warranted.

Original languageEnglish
Pages (from-to)17932-17944
Number of pages13
Issue number14
Publication statusPublished - 2016


  • Adjuvant breast cancer
  • Chemotherapy
  • Hormonal receptors
  • Trastuzumab
  • Triple positive

ASJC Scopus subject areas

  • Oncology

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