Abstract
BackgroundTrastuzumab has changed the prognosis of HER2+ breast cancer. We aimed to investigate the prognosis of ER+/HER2+ patients treated with trastuzumab, thus to guide escalation endocrine treatment in ER+ breast cancer.MethodsER-positive early breast cancer patients operated at Ruijin Hospital between Jan. 2009 and Dec. 2017 were retrospectively included. Eligible patients were grouped as HER2-negative (HER2-neg) or HER2-positive with trastuzumab treatment (HER2-pos-T). Kaplan-Meier analysis and Cox proportional hazards model were used to compare the disease-free survival (DFS) and overall survival (OS) between these two groups.ResultsA total of 3761 patients were enrolled: 3313 in the HER2-neg group and 448 in the HER2-pos-T group. Patients in the HER2-pos-T group were associated with pre/peri-menopause, higher histological grade, LVI, higher Ki-67 level, lower ER and PR levels (all P < 0.05). At a median follow-up of 62 months, 443 DFS events and 191 deaths were observed. The estimated 5-year DFS rate was 89.7% in the HER2-neg group and 90.2% in the HER2-pos-T group (P = 0.185), respectively. Multivariable analysis demonstrated that patients in the HER2-pos-T group had a better DFS than patients in the HER2-neg group (HR 0.52, 95% CI: 0.37–0.73, P < 0.001). The estimated 5-year OS rates were 96.0% and 96.3% in the two groups, respectively (P = 0.133). Multivariate analysis found that HER2-pos-T group was still associated with significantly better OS compared with the HER2-neg group (HR 0.38, 95% CI: 0.22–0.67, P = 0.037).ConclusionER+/HER2+ breast cancer patients treated with trastuzumab were associated with superior outcome compared with ER+/HER2- patients, indicating HER2-positivity itself may not be an adverse factor for ER+ patients in the era of trastuzumab.
Highlights
Breast cancer is the most common cancer and the leading cause of death in women
Should estrogen receptor (ER)+/human epidermal growth factor 2 (HER2)+ still be considered as an indicator of poor prognosis in the era of antiHER2 treatment? In current study, we aimed to investigate the prognosis of ER+/HER2+ breast cancer patients treated with trastuzumab compared with ER+/HER2patients, to guide us to select appropriate endocrine treatment decision making
After adjusting for these characteristics, the disease-free survival (DFS) and overall survival (OS) rates were significantly better for ER+/HER2+ patients treated with trastuzumab than those with ER+/HER2- tumor, indicating HER2positivity itself may not be an adverse factor for ER+ patients if they were treated with trastuzumab, which may guide further clinical treatment decision making
Summary
Breast cancer is the most common cancer and the leading cause of death in women. More than 2,088,849 new cases of breast cancer were estimated worldwide in 2018 [1]. Breast cancer can be categorized into at least four subtypes based on the status of molecular markers for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) [2]. About 15–20% of patients with breast cancer have HER2-amplfied and/or overexpressed tumors and about half HER2+ tumors express hormone receptor (HR) [3]. Clinicians tended to recommend escalation endocrine therapy for patients with HR+/HER2+ disease, such as ovarian function suppression (OFS) in pre-menopausal women. Trastuzumab has changed the prognosis of HER2+ breast cancer. We aimed to investigate the prognosis of ER+/HER2+ patients treated with trastuzumab, to guide escalation endocrine treatment in ER+ breast cancer
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