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Differences in axillary response and treatment implications in HER2 positive node positive breast cancer during
Exian Mou1,2, Juan Ji3, Shiwei Liu2
1Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Abstract:
Explore whether the axillary outcomes differ among HER2 positive subgroups receiving standard dual-targeted therapy, aiming to identify subgroups exhibiting enhanced sensitivity to NAT among HER2-positive/node-positive breast cancer patients. HER2 positive female patients with biopsy-proven node-positive disease from April 2020 to May 2023 were included. All patients underwent standard Neoadjuvant HER2-targeted dual therapy and axillary lymph node dissection (ALND) at Breast Surgery Center of Sichuan Cancer Hospital. Univariate and multivariate analyses were used to identify factors associate with axillary pathological complete response (ApCR). Statistical analysis and graphing were performed using SPSS 24.0 and GraphPad Prism 9.0 software. This study enrolled 215 HER2 positive patients with a total ApCR rate of 76.7%, which included 49 HER2 2+/FISH + and 166 HER2 3 + cases with approximate ApCR rates of 63.3% and 80.7% (P = 0.011). Univariate and multivariate analysis indicated that HER2 3 + disease (OR = 2.43, 95% CI 1.21-4.88, P = 0.012), Ki-67 ≥ 20% disease (OR = 3.00, 95% CI 1.26-7.13, P = 0.013) and NAC regimen of TCb (OR = 2.71, 95% CI 1.39-5.38, P = 0.004) were more likely to achieve ApCR. Further subgroup analysis revealed that HER2 3 + patients receiving TCb regimen showed the highest ApCR rate of 88% compared to other subgroups. HER2 3 + breast cancer had a higher ApCR rate than HER2 2+/FISH + breast cancer during Neoadjuvant HER2-targeted dual therapy. HER2 positive patients could benefit from NAC regimen of TCb in axillary response.
Insights
HER2-positive breast cancer patients with HER2 3+ disease and high Ki-67 levels showed better axillary pathological complete response (ApCR) to neoadjuvant therapy. The TCb regimen significantly improved ApCR rates, especially in HER2 3+ subgroups.
Area of Science:
- Oncology
- Breast Cancer Research
- Molecular Diagnostics
Background:
- HER2-positive breast cancer requires targeted therapies.
- Neoadjuvant therapy (NAT) aims to reduce tumor burden before surgery.
- Axillary staging is crucial for treatment decisions in node-positive breast cancer.
Purpose of the Study:
- To investigate axillary outcomes in HER2-positive breast cancer subgroups receiving standard dual-targeted therapy.
- To identify patient subgroups with enhanced sensitivity to neoadjuvant therapy (NAT).
- To evaluate factors associated with axillary pathological complete response (ApCR).
Main Methods:
- Retrospective analysis of 215 HER2-positive, node-positive female breast cancer patients.
- Patients received standard neoadjuvant HER2-targeted dual therapy and axillary lymph node dissection (ALND).
- Univariate and multivariate analyses were performed to identify predictors of ApCR.
Main Results:
- The overall ApCR rate was 76.7%.
- HER2 3+ disease (80.7% ApCR) showed significantly higher ApCR than HER2 2+/FISH+ disease (63.3%).
- Higher Ki-67 (≥20%) and the TCb neoadjuvant chemotherapy regimen were associated with increased likelihood of achieving ApCR.
Conclusions:
- HER2 3+ breast cancer patients demonstrate superior axillary response to neoadjuvant dual-targeted therapy compared to HER2 2+/FISH+ patients.
- The TCb neoadjuvant chemotherapy regimen is associated with improved axillary pathological complete response, particularly in HER2 3+ patients.
- Identifying specific HER2 subgroups and treatment regimens can optimize neoadjuvant treatment strategies for HER2-positive breast cancer.
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