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ER-poor and HER2-positive: a potential subtype of breast cancer to avoid axillary dissection in node positive patients after neoadjuvant chemo-trastuzumab therapy.

Li JW, Mo M, Yu KD, Chen CM, Hu Z, Hou YF, Di GH, Wu J, Shen ZZ, Shao ZM, Liu GY - PLoS ONE (2014)

Bottom Line: After NAC, each patient underwent standard axillary lymph node dissection and breast-conserving surgery or mastectomy.Of them, 157 were confirmed as axillary node positive by FNA (group-A) and 98 as axillary node negative either by FNA or impalpable (group-B).The ER-poor/HER2-positive subtype acquired the highest pNNR (79.6% in group-A and 87.9% in group-B, respectively) and the lowest rate of residual with ≥4 nodes involvement (1.9% and 3%, respectively) after PCrb plus trastuzumab.

View Article: PubMed Central - PubMed

Affiliation: Department of Breast Surgery, Shanghai Cancer Center/Cancer Institute, Fudan University, Shanghai, P. R. China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P. R. China.

ABSTRACT

Purpose: The study was to estimate the likelihood of axillary downstaging and to identify the factors predicting a pathologically node negative status after neoadjuvant chemotherapy (NAC) with or without trastuzumab in HER2-positive breast cancer.

Methods: Patients with HER2-positive, stage IIa-IIIc breast cancer were enrolled. Axillary status was evaluated by palpation and fine needle aspiration (FNA) before NAC. All patients received 4-6 cycles of PCrb (paclitaxel 80 mg/m2 and carboplatin AUC = 2 d1, 8, and 15 of a 28-day cycle, or paclitaxel 175 mg/m2 and carboplatin AUC = 6 every-3-week) and were non-randomly administered trastuzumab (2 mg/kg weekly or 6 mg/kg every-3-week) or not. After NAC, each patient underwent standard axillary lymph node dissection and breast-conserving surgery or mastectomy. And some patients received sentinel lymph node biopsy (SLNB) before axillary dissection.

Results: Between November-2007 and June-2013, 255 patients were enrolled. Of them, 157 were confirmed as axillary node positive by FNA (group-A) and 98 as axillary node negative either by FNA or impalpable (group-B). After axillary dissection, the overall pathologically node negative rates (pNNR) were 52.9% in group-A and 69.4% in group-B. The ER-poor/HER2-positive subtype acquired the highest pNNR (79.6% in group-A and 87.9% in group-B, respectively) and the lowest rate of residual with ≥4 nodes involvement (1.9% and 3%, respectively) after PCrb plus trastuzumab. In multivariate analysis, trastuzumab added and ER-poor status were independent factors in predicting a higher pNNR in HER2-positive breast cancer. Forty-six tested patients showed that the ER-poor/HER2-positive subtype acquired a considerable high pNNR and axillary status with SLNB was well macthed with the axillary dissection.

Conclusions: ER-poor/HER2-positive subtype of breast cancer is a potential candidate for undergoing sentinel lymph node biopsy instead of regional node dissection for accurate axillary evaluation after effective downstaging by neoadjuvant chemo-trastuzumab therapy.

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Multivariate regression analysis for axillary pNNR.NAC =  neoadjuvant chemotherapy; pNNR =  pathologically node negative rate; P =  paclitaxel; Crb =  carboplatin; H =  Trastuzumab (Herceptin). In multivariate analysis, trastuzumab added and ER-poor status showed higher pNNR in HER2-positive breast cancer.
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pone-0114646-g002: Multivariate regression analysis for axillary pNNR.NAC =  neoadjuvant chemotherapy; pNNR =  pathologically node negative rate; P =  paclitaxel; Crb =  carboplatin; H =  Trastuzumab (Herceptin). In multivariate analysis, trastuzumab added and ER-poor status showed higher pNNR in HER2-positive breast cancer.

Mentions: After axillary dissection, the overall pNNR were 52.7% and 69.4% in group-A and group-B, respectively. Axillary pNNR was highly correlated with the pCR rate of the primary site (p<0.0001). With the PCrbH regimen, 61.6% patients achieved pNNR in group-A and 81.5% in group-B, which were significantly higher than those treated with the PCrb regimen (p = 0.011 in group-A and p = 0.004 in group-B). The outcomes of axillary dissection in different patient subgroups were listed in Table 2. The subtype of ER-poor and HER2-positive breast cancer treated with neoadjuvant PCrbH showed the highest pNNR (79.6% in group-A and 87.9% in group-B) and the least residual (≥4 nodes) involvement (1.9% in group-A and 3% in group-B). These findings were also confirmed by multivariate analysis which indicated that trastuzumab addition to NAC (HR = 2.933) and an ER-poor status (HR = 2.873) may be related factors for predicting a higher pNNR after NAC in HER2-positive breast cancer (Fig. 2).


ER-poor and HER2-positive: a potential subtype of breast cancer to avoid axillary dissection in node positive patients after neoadjuvant chemo-trastuzumab therapy.

Li JW, Mo M, Yu KD, Chen CM, Hu Z, Hou YF, Di GH, Wu J, Shen ZZ, Shao ZM, Liu GY - PLoS ONE (2014)

Multivariate regression analysis for axillary pNNR.NAC =  neoadjuvant chemotherapy; pNNR =  pathologically node negative rate; P =  paclitaxel; Crb =  carboplatin; H =  Trastuzumab (Herceptin). In multivariate analysis, trastuzumab added and ER-poor status showed higher pNNR in HER2-positive breast cancer.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4263615&req=5

pone-0114646-g002: Multivariate regression analysis for axillary pNNR.NAC =  neoadjuvant chemotherapy; pNNR =  pathologically node negative rate; P =  paclitaxel; Crb =  carboplatin; H =  Trastuzumab (Herceptin). In multivariate analysis, trastuzumab added and ER-poor status showed higher pNNR in HER2-positive breast cancer.
Mentions: After axillary dissection, the overall pNNR were 52.7% and 69.4% in group-A and group-B, respectively. Axillary pNNR was highly correlated with the pCR rate of the primary site (p<0.0001). With the PCrbH regimen, 61.6% patients achieved pNNR in group-A and 81.5% in group-B, which were significantly higher than those treated with the PCrb regimen (p = 0.011 in group-A and p = 0.004 in group-B). The outcomes of axillary dissection in different patient subgroups were listed in Table 2. The subtype of ER-poor and HER2-positive breast cancer treated with neoadjuvant PCrbH showed the highest pNNR (79.6% in group-A and 87.9% in group-B) and the least residual (≥4 nodes) involvement (1.9% in group-A and 3% in group-B). These findings were also confirmed by multivariate analysis which indicated that trastuzumab addition to NAC (HR = 2.933) and an ER-poor status (HR = 2.873) may be related factors for predicting a higher pNNR after NAC in HER2-positive breast cancer (Fig. 2).

Bottom Line: After NAC, each patient underwent standard axillary lymph node dissection and breast-conserving surgery or mastectomy.Of them, 157 were confirmed as axillary node positive by FNA (group-A) and 98 as axillary node negative either by FNA or impalpable (group-B).The ER-poor/HER2-positive subtype acquired the highest pNNR (79.6% in group-A and 87.9% in group-B, respectively) and the lowest rate of residual with ≥4 nodes involvement (1.9% and 3%, respectively) after PCrb plus trastuzumab.

View Article: PubMed Central - PubMed

Affiliation: Department of Breast Surgery, Shanghai Cancer Center/Cancer Institute, Fudan University, Shanghai, P. R. China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P. R. China.

ABSTRACT

Purpose: The study was to estimate the likelihood of axillary downstaging and to identify the factors predicting a pathologically node negative status after neoadjuvant chemotherapy (NAC) with or without trastuzumab in HER2-positive breast cancer.

Methods: Patients with HER2-positive, stage IIa-IIIc breast cancer were enrolled. Axillary status was evaluated by palpation and fine needle aspiration (FNA) before NAC. All patients received 4-6 cycles of PCrb (paclitaxel 80 mg/m2 and carboplatin AUC = 2 d1, 8, and 15 of a 28-day cycle, or paclitaxel 175 mg/m2 and carboplatin AUC = 6 every-3-week) and were non-randomly administered trastuzumab (2 mg/kg weekly or 6 mg/kg every-3-week) or not. After NAC, each patient underwent standard axillary lymph node dissection and breast-conserving surgery or mastectomy. And some patients received sentinel lymph node biopsy (SLNB) before axillary dissection.

Results: Between November-2007 and June-2013, 255 patients were enrolled. Of them, 157 were confirmed as axillary node positive by FNA (group-A) and 98 as axillary node negative either by FNA or impalpable (group-B). After axillary dissection, the overall pathologically node negative rates (pNNR) were 52.9% in group-A and 69.4% in group-B. The ER-poor/HER2-positive subtype acquired the highest pNNR (79.6% in group-A and 87.9% in group-B, respectively) and the lowest rate of residual with ≥4 nodes involvement (1.9% and 3%, respectively) after PCrb plus trastuzumab. In multivariate analysis, trastuzumab added and ER-poor status were independent factors in predicting a higher pNNR in HER2-positive breast cancer. Forty-six tested patients showed that the ER-poor/HER2-positive subtype acquired a considerable high pNNR and axillary status with SLNB was well macthed with the axillary dissection.

Conclusions: ER-poor/HER2-positive subtype of breast cancer is a potential candidate for undergoing sentinel lymph node biopsy instead of regional node dissection for accurate axillary evaluation after effective downstaging by neoadjuvant chemo-trastuzumab therapy.

Show MeSH
Related in: MedlinePlus