Abstract
ABSTRACT Background HER2 positive (HER2+) disease is relatively uncommon in women with small, early breast cancers (BC), accounting for approximately ∼10% of the cases. Several trials have shown benefit of adjuvant trastuzumab (T) for node positive or supra-centimetric HER2+ BC but there are limited data concerning infra-centimetric HER2+ disease. The aim of this study is to identify the pattern of use of T and risk of recurrence in small HER2+ tumors. Methods This observational, multicenter, retrospective study was conducted in 9 oncology centers in Sicily during 2005-2011. Multifocal and metastatic tumors were excluded. Results 65 cases were evaluated. Median age was 52.7 years (range 36-77). Tumor stage: T1a 21 (32.3%) and T1b 44 (67.9%). Nodal status by sentinel biopsy: 48 (74%) had node-negative disease. Invasive histological type: ductal 61 (93.9%), lobular 3 (4.6%) and medullary 1 (1.5%). Histological grade: G1 2 (3.0%), G2 44 (67.7%) and G3 19 (29.2%). The Ki 67 index was ≥ 13% in 45 (69.2%). Hormonal receptor status: Positive 42 (64.7%). Local treatment: breast conservative surgery and local irradiation 57 (87.7%) and mastectomy 8 (12.3%). Systemic treatment: 47 (72.3%) received T in combination and/or after adjuvant chemotherapy (mostly anthracycline/taxane-based). Cardiac Toxicity: 2 cases of asymptomatic and transient left ventricular ejection fraction decrease below 20% after T. With a median follow-up of 35.4 months, there were 5 (7.7%) metastatic recurrences, 2/18 (11.1%) in the non-T treated group, and 3/47 (6.4%) in the T-treated group. At 60 months, relapse-free survival estimates were 80.7% and 91.2% in the non-T and T-treated groups (p > 0.05), respectively. Conclusions Our data suggest that infra-centimetric HER2+ tumors are associated with a general poor outcome and Trastuzumab-based therapies are justified. Future evaluation of dual anti-HER2 blockade in combination with chemotherapy seems warranted in this setting. Disclosure All authors have declared no conflicts of interest.
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