Can neoadjuvant systemic therapy provide additional benefits for T1 HER2+ breast cancer patients: a subgroup analysis...

Area of Science:

• Oncology
• Breast Cancer Research
• Clinical Trial Analysis

Background:

• Neoadjuvant systemic therapy (NAST) is a critical treatment for HER2-positive (HER2+) breast cancer.
• The use of NAST for tumors smaller than 2 cm remains a subject of debate.
• Identifying optimal treatment strategies for early-stage HER2+ breast cancer is essential.

Purpose of the Study:

• To investigate the survival outcomes of neoadjuvant systemic therapy (NAST) in HER2-positive breast cancer patients with tumors less than 2 cm.
• To determine if NAST provides additional survival benefits in specific subgroups, including those with lymph node metastasis or hormone receptor negativity.
• To develop predictive models for treatment response and survival in this patient population.

Main Methods:

• Utilized the Surveillance, Epidemiology, and End Result (SEER) database, analyzing 7961 patients with HER2+ breast cancer.
• Employed multivariate Cox analysis to identify independent prognostic factors.
• Conducted subgroup and Kaplan-Meier analyses to evaluate survival benefits of NAST versus adjuvant systemic therapy (AST) across different risk characteristics.
• Constructed and validated nomograms to predict patient outcomes.

Main Results:

• Out of 7961 patients, 1137 (14.3%) received NAST. Overall, NAST was associated with poorer overall survival (OS) and breast cancer-specific survival (BCSS) compared to AST.
• Multivariate analysis confirmed NAST significantly impacted prognosis.
• Subgroup analyses revealed comparable OS between NAST and AST in T1c, hormone receptor-negative, and age 61-69 subgroups, but worse BCSS with NAST.
• No additional survival benefit from NAST was observed even in patients with N3 lymph node metastasis.

Conclusions:

• Neoadjuvant systemic therapy (NAST) does not confer additional survival benefits for patients with T1 HER2-positive breast cancer, irrespective of lymph node metastasis, T1c stage, or hormone receptor negativity.
• These findings support the development of individualized treatment strategies for HER2-positive breast cancer.
• The study highlights the need for careful consideration of NAST in early-stage HER2+ breast cancer management.