Effectiveness of neo-adjuvant systemic therapy with trastuzumab for basal HER2 type breast cancer: results from retrospective cohort study of Japan Breast Cancer Research Group (JBCRG)-C03
Effectiveness of neo-adjuvant systemic therapy with trastuzumab for basal HER2 type breast cancer: results from retrospective cohort study of Japan Breast Cancer Research Group (JBCRG)-C03
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DOI：
10.1007/s10549-018-4873-0
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发表时间：
2018-07
影响因子：
3.8
通讯作者：
Y. Sagara;M. Takada;Y. Ohi;S. Ohtani;S. Kurozumi;Kenichi Inoue;Y. Kosaka;M. Hattori;T. Yamashita;S. Takao;N. Sato;H. Iwata;M. Kurosumi;M. Toi
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作者：
Y. Sagara;M. Takada;Y. Ohi;S. Ohtani;S. Kurozumi;Kenichi Inoue;Y. Kosaka;M. Hattori;T. Yamashita;S. Takao;N. Sato;H. Iwata;M. Kurosumi;M. Toi
虽然人表皮生长因子受体2（HER 2）靶向治疗显著改善了HER 2富集乳腺癌患者的预后，但不同的临床获益和基因表达分析表明，HER 2亚群存在差异。我们的目的是调查是否基础HER 2亚型的乳腺癌有显着的characteristics.MethodsWe进行了一项亚组研究，通过使用数据从一个回顾性的多机构队列JBCRG-C 03。在2001年至2011年期间，我们确定了184名合格的患者，他们接受了与曲妥珠单抗同步的新辅助化疗（NAC）治疗激素受体阴性和HER 2阳性乳腺癌。我们将基础型HER 2亚型乳腺癌定义为HER 2阳性，ER/PgR阴性，基础标志物（EGFR，CK 14或CK 5/6）阳性。病理完全缓解（pCR）和无病生存（DFS）率之间进行了比较两个subtypes.ResultsA共127（69.0%）例患者达到pCR后NAC和29（15.8%）例患者经历了DFS事件在42个月的中位随访期（四分位距26-58个月）。尽管基础HER 2亚型与DFS差相关，（3年DFS：非基础HER 2，95.0%;基础HER 2，86.9%;校正HR 3.4; 95% CI 1.2-14.5），（pCR：非基础HER 2，75%;基础HER 2，66.7%;校正OR 0.60; 95%CI 0.27-1.28），基础标志物表达程度与pCR率也无显著相关性。但与曲妥珠单抗同期新辅助化疗后的pCR率相当。即使对于NAC后获得充分临床应答的病例，也需要针对基础HER 2型的不同治疗方法。
PurposeWhile human epidermal growth factor receptor 2 (HER2) target therapies have significantly improved the prognosis of patients with HER2-enriched breast cancer, differing clinical benefits and gene expression analyses suggest a divergent HER2 subgroup. We aimed to investigate whether the basal HER2 subtype of breast cancer has distinguished characteristics.MethodsWe performed a substudy by using data from a retrospective multi-institutional cohort of JBCRG-C03. Between 2001 and 2011, we identified 184 eligible patients who received concurrent neo-adjuvant chemotherapy (NAC) with trastuzumab for hormone receptor-negative and HER2-positive breast cancer. We defined basal HER2 subtype breast cancer as HER2-positive, ER/PgR-negative, and basal markers (EGFR, CK14 or CK5/6) positive by immunohistochemistrical evaluation. The pathologic complete response (pCR) and disease-free survival (DFS) rates were compared between the two subtypes.ResultsA total of 127 (69.0%) patients achieved pCR after NAC and 29 (15.8%) patients experienced events of DFS within a 42 month median follow-up period (interquartile range 26–58 months). Although the basal HER2 subtype was related with poor DFS (3 year DFS: non-basal HER2, 95.0%; basal HER2, 86.9%; adjusted HR 3.4; 95% CI 1.2–14.5), neither the subtype (pCR: non-basal HER2, 75%; basal HER2, 66.7%; adjusted OR 0.60; 95% CI 0.27–1.28) nor the degree of expression of basal markers was significantly related with the pCR rate.ConclusionBasal HER2 phenotype showed poor DFS, but equivalent pCR rate after concurrent neo-adjuvant chemotherapy with trastuzumab. A different treatment approach to basal-HER2 type is needed even for cases that achieved adequate clinical response after NAC.