BACKGROUND: Adjuvant trastuzumab (AT) is known to significantly improve survival of women with HER2(+) early breast cancer. This study explores the use and nonuse of AT in early breast cancer, as well as the efficacy in a neoadjuvant and adjuvant population, within a routine clinical setting. PATIENTS AND METHODS: Histopathology reports of invasive breast cancer resected at Imperial College Healthcare NHS Trust (ICHT) between January 2006 and December 2008 were reviewed. HER2(+) patients were identified and their case notes reviewed. In addition, patients who received AT at our center but underwent surgery elsewhere were included in the efficacy and safety analyses. RESULTS: The local HER2(+) rate was 13.1%, with 54.5% of these patients receiving AT. A total of 128 patients received AT (85 local and 43 referrals from elsewhere). Neoadjuvant chemotherapy (CT) followed by postoperative AT was associated with a significantly increased risk of recurrence compared with adjuvant CT and then AT (hazard ratio [HR] 18.6 [95% CI, 1.8-152.2]; P = .013). The proportion of patients who were disease free at 3 years from primary therapy was 96.4% (95% CI, 89.8%-100%) for adjuvant therapy, compared with 72.0% (95% CI, 56.5%-91.6%) for neoadjuvant therapy. AT was omitted in 49 HER2(+) patients; the main reason for AT omission was clinical judgment that the breast cancer was low risk. Patients treated with AT had a significantly decreased risk of recurrence (HR 0.27 [95% CI, 0.08-0.97]; P = .04) compared with the untreated patients. The majority of untreated relapses were in patients in whom there was an original intent to use AT. The proportion alive at 3 years for adjuvant CT, neoadjuvant CT, and untreated AT was 100%, 74.5%, and 92.7% respectively. CONCLUSION: The overall efficacy and safety of AT in our routine clinical setting is comparable to the large randomized trials. HER2(+) patients who underwent neoadjuvant CT had a significantly increased risk of disease recurrence compared with patients treated with adjuvant CT followed by trastuzumab. Untreated patients had an increased risk of recurrence.
BACKGROUND: Adjuvant trastuzumab (AT) is known to significantly improve survival of women with HER2(+) early breast cancer. This study explores the use and nonuse of AT in early breast cancer, as well as the efficacy in a neoadjuvant and adjuvant population, within a routine clinical setting. PATIENTS AND METHODS: Histopathology reports of invasive breast cancer resected at Imperial College Healthcare NHS Trust (ICHT) between January 2006 and December 2008 were reviewed. HER2(+) patients were identified and their case notes reviewed. In addition, patients who received AT at our center but underwent surgery elsewhere were included in the efficacy and safety analyses. RESULTS: The local HER2(+) rate was 13.1%, with 54.5% of these patients receiving AT. A total of 128 patients received AT (85 local and 43 referrals from elsewhere). Neoadjuvant chemotherapy (CT) followed by postoperative AT was associated with a significantly increased risk of recurrence compared with adjuvant CT and then AT (hazard ratio [HR] 18.6 [95% CI, 1.8-152.2]; P = .013). The proportion of patients who were disease free at 3 years from primary therapy was 96.4% (95% CI, 89.8%-100%) for adjuvant therapy, compared with 72.0% (95% CI, 56.5%-91.6%) for neoadjuvant therapy. AT was omitted in 49 HER2(+) patients; the main reason for AT omission was clinical judgment that the breast cancer was low risk. Patients treated with AT had a significantly decreased risk of recurrence (HR 0.27 [95% CI, 0.08-0.97]; P = .04) compared with the untreated patients. The majority of untreated relapses were in patients in whom there was an original intent to use AT. The proportion alive at 3 years for adjuvant CT, neoadjuvant CT, and untreated AT was 100%, 74.5%, and 92.7% respectively. CONCLUSION: The overall efficacy and safety of AT in our routine clinical setting is comparable to the large randomized trials. HER2(+) patients who underwent neoadjuvant CT had a significantly increased risk of disease recurrence compared with patients treated with adjuvant CT followed by trastuzumab. Untreated patients had an increased risk of recurrence.
Authors: Stefania Mantarro; Marta Rossi; Martina Bonifazi; Roberto D'Amico; Corrado Blandizzi; Carlo La Vecchia; Eva Negri; Lorenzo Moja Journal: Intern Emerg Med Date: 2015-12-28 Impact factor: 3.397
Authors: Christopher M Gallagher; Kenneth More; Tripthi Kamath; Anthony Masaquel; Annie Guerin; Raluca Ionescu-Ittu; Marjolaine Gauthier-Loiselle; Roy Nitulescu; Nicholas Sicignano; Elizabeth Butts; Eric Q Wu; Brian Barnett Journal: Breast Cancer Res Treat Date: 2016-04-23 Impact factor: 4.872
Authors: M Campiglio; R Bufalino; M Sasso; E Ferri; P Casalini; V Adamo; A Fabi; R Aiello; F Riccardi; E Valle; V Scotti; G Tabaro; D Giuffrida; E Tarenzi; A Bologna; G Mustacchi; F Bianchi; A Balsari; S Ménard; E Tagliabue Journal: Breast Cancer Res Treat Date: 2013-08-13 Impact factor: 4.872
Authors: E C Inwald; O Ortmann; F Zeman; M Koller; F Hofstädter; M Gerstenhauer; M Klinkhammer-Schalke Journal: Biomed Res Int Date: 2014-03-20 Impact factor: 3.411
Authors: Christopher M Gallagher; Kenneth More; Anthony Masaquel; Tripthi Kamath; Annie Guerin; Raluca Ionescu-Ittu; Roy Nitulescu; Marjolaine Gauthier-Loiselle; Nicholas Sicignano; Elizabeth Butts; Eric Q Wu; Brian Barnett Journal: Springerplus Date: 2016-03-31
Authors: Carlo Palmieri; Iain Rj Macpherson; Kelvin Yan; Felipe Ades; Pippa Riddle; Riz Ahmed; Waheeda Owadally; Barbara Stanley; Deep Shah; Ondrej Gojis; Adam Januszewski; Conrad Lewanski; Rebecca Asher; Daniel Lythgoe; Evandro de Azambuja; Mark Beresford; Sacha J Howell Journal: Oncotarget Date: 2016-03-15
Authors: Suzanne A Eccles; Eric O Aboagye; Simak Ali; Annie S Anderson; Jo Armes; Fedor Berditchevski; Jeremy P Blaydes; Keith Brennan; Nicola J Brown; Helen E Bryant; Nigel J Bundred; Joy M Burchell; Anna M Campbell; Jason S Carroll; Robert B Clarke; Charlotte E Coles; Gary J R Cook; Angela Cox; Nicola J Curtin; Lodewijk V Dekker; Isabel dos Santos Silva; Stephen W Duffy; Douglas F Easton; Diana M Eccles; Dylan R Edwards; Joanne Edwards; D Evans; Deborah F Fenlon; James M Flanagan; Claire Foster; William M Gallagher; Montserrat Garcia-Closas; Julia M W Gee; Andy J Gescher; Vicky Goh; Ashley M Groves; Amanda J Harvey; Michelle Harvie; Bryan T Hennessy; Stephen Hiscox; Ingunn Holen; Sacha J Howell; Anthony Howell; Gill Hubbard; Nick Hulbert-Williams; Myra S Hunter; Bharat Jasani; Louise J Jones; Timothy J Key; Cliona C Kirwan; Anthony Kong; Ian H Kunkler; Simon P Langdon; Martin O Leach; David J Mann; John F Marshall; Lesley Martin; Stewart G Martin; Jennifer E Macdougall; David W Miles; William R Miller; Joanna R Morris; Sue M Moss; Paul Mullan; Rachel Natrajan; James P B O'Connor; Rosemary O'Connor; Carlo Palmieri; Paul D P Pharoah; Emad A Rakha; Elizabeth Reed; Simon P Robinson; Erik Sahai; John M Saxton; Peter Schmid; Matthew J Smalley; Valerie Speirs; Robert Stein; John Stingl; Charles H Streuli; Andrew N J Tutt; Galina Velikova; Rosemary A Walker; Christine J Watson; Kaye J Williams; Leonie S Young; Alastair M Thompson Journal: Breast Cancer Res Date: 2013-10-01 Impact factor: 6.466