Abstract
Purpose: The neoadjuvant use of pertuzumab and trastuzumab with chemotherapy improves the pathologic complete response (pCR) in early HER2+ breast cancer. The aim of this study was to determine the pCR rate obtained with dual HER2 blockade in routine clinical practice. The secondary and tertiary objective was to investigate the impact of neoadjuvant systemic therapy (NST) on performing breast-conserving surgery and survival data. Methods: This was a multicentre, retrospective, observational study in patients with stage II and III HER2+ early breast cancer who received pertuzumab and trastuzumab-based NST. Data were collected from patients’ medical records. Results: Eighty-two patients were included in the study treated in 8 cancer centers in Hungary between March 2015 and January 2020. The study included women with a median age of 50.3 years. The majority of the patients (95%) received a sequence of anthracycline-based chemotherapy followed by docetaxel. pCR was achieved in 54% of the cases. As a result of NST a significant increase of conservative breast surgeries (33% vs. 3.6% planned, p = 0.0001) was observed. Ki67 expression and neutrophil-to-lymphocyte ratio (NLR) significantly predicted pCR. None of the variables were independent predictors of DFS. Conclusion: The pCR rate achieved in our study demonstrates the reproducibility of trial data in a real-world population. The rate of breast-conserving surgery was significantly increased.
Highlights
Neoadjuvant systemic therapy (NST) has many advantages since it serves as a tool for in vitro assessment of response, it allows less aggressive surgery, more breast-conserving therapy, and early treatment of micro-metastatic disease [1,2,3,4]
The majority of the patients (95%) received a sequence of anthracycline-based chemotherapy followed by docetaxel. pathologic complete response (pCR) was achieved in 54% of the cases
The pCR rate achieved in our study demonstrates the reproducibility of trial data in a real-world population
Summary
Neoadjuvant systemic therapy (NST) has many advantages since it serves as a tool for in vitro assessment of response, it allows less aggressive surgery, more breast-conserving therapy, and early treatment of micro-metastatic disease [1,2,3,4]. The primary trial supporting the approval of pertuzumab for use in combination with trastuzumab and docetaxel as NST for patients with HER2+ EBC was the phase II NEOSPHERE trial. In this trial, the results achieved with trastuzumab were improved with the addition of pertuzumab, reaching pCR rates of 39% [9,10,11]. Treatment patterns and clinical experience of obtaining pCR with dual blockade via pertuzumab and trastuzumab in patients with HER2+ stage II-III EBC have not been assessed extensively in the real-world setting
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