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Building Up a High-throughput Screening Platform to Assess the Heterogeneity of HER2 Gene Amplification in Breast Cancers
Published on: December 5, 2017
Trends in the Management of Small HER2-Positive Breast Cancers
Carolin Mueller1,2, Rahul Rangan3, Megan Kruse4
1Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA.
Background:
The treatment approach for small HER2-positive (+) breast cancers seeks to optimize efficacy while minimizing potential overtreatment and associated toxicities. This study aims to evaluate recent trends in treatment patterns for small HER2+ tumors.
Methods:
Patients diagnosed with HER2+, cT1, cN0/pN0 breast cancer treated at a single institution from January 2018 to December 2022 were included. Clinicopathological, treatment, and follow-up data were collected and analyzed.
Patients And Results:
A total of 207 patients were included. Mean age was 63 (± 12.0) years. T category included cT1a in 12.1% (n = 25), cT1b in 28.0% (n = 58), and cT1c in 57.5% (n = 119), while 2.4% (n = 5) had clinical T1 category without further specification. Moreover, 74.4% (n = 154) were hormone receptor positive. Also, 66.7% (n = 138) received adjuvant therapy, 12.6% (n = 26) received neoadjuvant systemic therapy (NAT), and 12.1% (n = 25) received no systemic therapy. Administered regimens included: trastuzumab monotherapy in 6.1% (n = 10), taxane/trastuzumab in 55.5% (n = 91), taxane/carboplatin/trastuzumab in 18.9% (n = 31), and taxane/carboplatin/trastuzumab/pertuzumab in 15.2% (n = 25). In the 26 patients who received NAT, pathological complete response (pCR) was noted in 69.2% (n = 18). Overall, use of NAT increased from 2018 (7.1%) to 2021 (30.2%) and then decreased in 2022 (9.1%). The overall mastectomy rate was 35.3% (n = 73). Young age and multiple tumors were associated with a higher rate of mastectomy (age p < 0.001; multiple tumors p = 0.006). Upstaging of clinically node-negative patients occurred in 14.1% of patients at surgery.
Conclusion:
The treatment for cT1N0 HER2+ breast cancers includes primary surgery with adjuvant HER2-targeted therapy in combination with chemotherapy. Primary surgery may allow for an opportunity to deescalate adjuvant therapy with no impact on surgical plan.
Insights
This study on small HER2-positive breast cancer found that primary surgery followed by HER2-targeted therapy and chemotherapy is standard. Surgery may allow for de-escalation of adjuvant therapy without affecting outcomes.
Area of Science:
- Oncology
- Breast Cancer Research
- Clinical Treatment Strategies
Background:
- Optimizing treatment for small HER2-positive breast cancers is crucial to balance efficacy with reduced toxicity.
- Recent trends in treatment patterns for early-stage HER2-positive tumors require evaluation.
Purpose of the Study:
- To analyze treatment patterns for small HER2-positive, node-negative breast cancer.
- To assess the impact of neoadjuvant systemic therapy (NAT) and adjuvant therapy on outcomes.
Main Methods:
- Retrospective analysis of 207 patients with HER2-positive, cT1N0 breast cancer from 2018-2022.
- Data collected included clinicopathological features, treatment regimens, and follow-up information.
Main Results:
- Most patients (74.4%) were hormone receptor-positive. Adjuvant therapy was common (66.7%), with NAT used in 12.6%.
- Trastuzumab-based regimens were prevalent. Neoadjuvant systemic therapy (NAT) use peaked in 2021. Pathological complete response (pCR) after NAT was 69.2%.
- Mastectomy rates were 35.3%, associated with younger age and multiple tumors. 14.1% of node-negative patients were upstaged post-surgery.
Conclusions:
- Primary surgery combined with adjuvant HER2-targeted therapy and chemotherapy is the standard for cT1N0 HER2+ breast cancer.
- Primary surgery can facilitate de-escalation of adjuvant therapy without compromising the surgical plan or outcomes.
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