Susanna Nguy1, S Peter Wu2, Cheongeun Oh3, Naamit K Gerber4. 1. Department of Radiation Oncology, NYU Langone Health, New York, NY, USA. 2. Division of Biostastistics, NYU Langone Health, New York, NY, USA. 3. Holy Name Medical Center, Teaneck, NJ, USA. 4. Department of Radiation Oncology, NYU Langone Health, New York, NY, USA. naamit.gerber@nyulangone.org.
Abstract
PURPOSE: Anti-HER2 therapy delivered in the adjuvant setting for breast cancer is given in conjunction with cytotoxic chemotherapy. For HER2-positive (HER2+) patients who cannot tolerate chemotherapy, there is no randomized data regarding the role of anti-HER2 therapy without chemotherapy. METHODS: The National Cancer Database (NCDB) was queried for non-metastatic breast cancer patients with estrogen receptor-positive (ER+) and HER2+ breast cancer who received surgery and endocrine therapy, without chemotherapy from 2013 to 2016. Outcomes were compared between endocrine therapy alone (ET) or endocrine therapy with anti-HER2 therapy (ET + aHER2). Univariate and multivariate Cox-proportional hazards models were used to analyze the association between clinical characteristics and survival outcomes between groups. Propensity score matching (PSM) was performed to account for differences between the two groups. RESULTS: Of all patients with non-metastatic ER+/HER2+ breast cancer, we identified 9458 (20.5%) who did not receive chemotherapy. Of the 6741 patients who received ET, 17.2% also received aHER2 therapy. Median follow-up was 31.7 months (IQR 21.1-42.1). In the aHER2 group (vs. ET), there were more patients with older age, higher stage, node positivity, poorly or undifferentiated disease, lymphovascular invasion, lobular cancer, and Medicare insurance. Compared to the ET cohort, ET + aHER2 was not significantly associated with improved OS on multivariate analysis (HR 0.88 95% CI 0.68-1.15) or after propensity score matching (HR 0.80 95% CI 0.57-1.11). CONCLUSIONS: There is no significant difference in survival with the addition of HER2 therapy to endocrine therapy in ER+/HER2+ non-metastatic breast cancer patients who do not receive chemotherapy. To our knowledge, this is the largest series investigating this question.
PURPOSE: Anti-HER2 therapy delivered in the adjuvant setting for breast cancer is given in conjunction with cytotoxic chemotherapy. For HER2-positive (HER2+) patients who cannot tolerate chemotherapy, there is no randomized data regarding the role of anti-HER2 therapy without chemotherapy. METHODS: The National Cancer Database (NCDB) was queried for non-metastatic breast cancerpatients with estrogen receptor-positive (ER+) and HER2+ breast cancer who received surgery and endocrine therapy, without chemotherapy from 2013 to 2016. Outcomes were compared between endocrine therapy alone (ET) or endocrine therapy with anti-HER2 therapy (ET + aHER2). Univariate and multivariate Cox-proportional hazards models were used to analyze the association between clinical characteristics and survival outcomes between groups. Propensity score matching (PSM) was performed to account for differences between the two groups. RESULTS: Of all patients with non-metastatic ER+/HER2+ breast cancer, we identified 9458 (20.5%) who did not receive chemotherapy. Of the 6741 patients who received ET, 17.2% also received aHER2 therapy. Median follow-up was 31.7 months (IQR 21.1-42.1). In the aHER2 group (vs. ET), there were more patients with older age, higher stage, node positivity, poorly or undifferentiated disease, lymphovascular invasion, lobular cancer, and Medicare insurance. Compared to the ET cohort, ET + aHER2 was not significantly associated with improved OS on multivariate analysis (HR 0.88 95% CI 0.68-1.15) or after propensity score matching (HR 0.80 95% CI 0.57-1.11). CONCLUSIONS: There is no significant difference in survival with the addition of HER2 therapy to endocrine therapy in ER+/HER2+ non-metastatic breast cancerpatients who do not receive chemotherapy. To our knowledge, this is the largest series investigating this question.
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Authors: D J Slamon; B Leyland-Jones; S Shak; H Fuchs; V Paton; A Bajamonde; T Fleming; W Eiermann; J Wolter; M Pegram; J Baselga; L Norton Journal: N Engl J Med Date: 2001-03-15 Impact factor: 91.245
Authors: C L Vogel; M A Cobleigh; D Tripathy; J C Gutheil; L N Harris; L Fehrenbacher; D J Slamon; M Murphy; W F Novotny; M Burchmore; S Shak; S J Stewart Journal: Oncology Date: 2001 Impact factor: 2.935
Authors: Edith A Perez; Edward H Romond; Vera J Suman; Jong-Hyeon Jeong; George Sledge; Charles E Geyer; Silvana Martino; Priya Rastogi; Julie Gralow; Sandra M Swain; Eric P Winer; Gerardo Colon-Otero; Nancy E Davidson; Eleftherios Mamounas; Jo Anne Zujewski; Norman Wolmark Journal: J Clin Oncol Date: 2014-10-20 Impact factor: 44.544
Authors: D J Slamon; W Godolphin; L A Jones; J A Holt; S G Wong; D E Keith; W J Levin; S G Stuart; J Udove; A Ullrich Journal: Science Date: 1989-05-12 Impact factor: 47.728
Authors: M A Cobleigh; C L Vogel; D Tripathy; N J Robert; S Scholl; L Fehrenbacher; J M Wolter; V Paton; S Shak; G Lieberman; D J Slamon Journal: J Clin Oncol Date: 1999-09 Impact factor: 44.544
Authors: M D Pegram; A Lipton; D F Hayes; B L Weber; J M Baselga; D Tripathy; D Baly; S A Baughman; T Twaddell; J A Glaspy; D J Slamon Journal: J Clin Oncol Date: 1998-08 Impact factor: 44.544