TY - JOUR
T1 - Incidence of late relapses in patients with HER2-positive breast cancer receiving adjuvant trastuzumab
T2 - Combined analysis of NCCTG N9831 (Alliance) and NRG oncology/NSABP B-31
AU - Chumsri, Saranya
AU - Li, Zhuo
AU - Serie, Daniel J.
AU - Mashadi-Hossein, Afshin
AU - Colon-Otero, Gerardo
AU - Song, Nan
AU - Pogue-Geile, Katherine L.
AU - Gavin, Patrick G.
AU - Paik, Soonmyung
AU - Moreno-Aspitia, Alvaro
AU - Perez, Edith A.
AU - Aubrey Thompson, E.
N1 - Funding Information:
Supported by the National Cancer Institute of the National Institutes of Health under Award Numbers U10CA180821 and U10CA18082 (to the Alliance for Clinical Trials in Oncology), U24CA196171, U10CA180868, UG1CA189867, U10CA180822, and U24CA196067; Genentech; and in part by funds to E.A.T. from the Breast Cancer Research Foundation (Grant No. BCRF-17-161), Bankhead-Coley Research Program (Grant No. 6BC05), and the DONNA Foundation.
Funding Information:
Katherine L. Pogue-Geile Research Funding: National Surgical Adjuvant Breast and Bowel Project (Inst) Patents, Royalties, Other Intellectual Property: US Patent Application Serial No. 14/738,757, entitled “Methods of Subtyping CRC and their Association with Treatment of Colon Cancer Patients with Oxaliplatin,” published on December 24, 2015.
Publisher Copyright:
Copyright © 2019 American Society of Clinical Oncology. All rights reserved.
PY - 2019
Y1 - 2019
N2 - PURPOSE Recent trials have shown potential benefit of extended adjuvant endocrine therapy and relatively high risk of recurrence (RoR) after 5 years in hormone receptor-positive (HR+) human epidermal growth factor receptor 2–negative (HER22) breast cancer. Although risk of late relapse in HR+ HER22 breast cancer is fairly well defined, the risk in HER2-positive (HER2+) breast cancer treated with adjuvant trastuzumab-based chemotherapy remains largely unknown. METHODS We included 3,177 patients with HER2+ breast cancer treated with adjuvant chemotherapy alone or with trastuzumab from the North Central Cancer Treatment Group N9831 (ClinicalTrials.gov identifier: NCT00005970) and National Surgical Adjuvant Breast and Bowel Project B-31 (ClinicalTrials.gov identifier: NCT00004067) trials. RESULTS Overall, HR+ breast cancer was significantly associated with improved recurrence-free survival (RFS) during the first 5 years (hazard ratio, 0.65; 95% CI, 0.56 to 0.77; P, .001). Among patients treated with trastuzumab, cumulative hazard for RFS was lower in patients with HR+ HER2+ breast cancer during the first 5 years (10.96% v 17.48%; hazard ratio, 0.60; 95% CI, 0.45 to 0.79; P, .001). However, there was no significant difference in RFS based on HR status during years 5 to 10 (hazard ratio, 1.32; 95% CI, 0.93 to 1.88; P = .12). A comparable degree of trastuzumab benefit was observed in HR+ and HR2 breast cancers (P for interaction = .87). Furthermore, we observed low RoR in years 5 to 10 among patients with HR+ HER2+ breast cancer: 3.23% in patients without lymph node involvement (N0) and 6.39% in patients with involvement of one to three lymph nodes (N1). CONCLUSION The benefit of adjuvant trastuzumab persists for a long time. A distinct pattern of recurrence was observed between HR+ and HR2 HER2+ disease but with similar degree of benefit from adjuvant trastuzumab. RoR in years 5 to 10 in HR+ HER2+ breast cancer is low, particularly in patients with N0 or N1 disease.
AB - PURPOSE Recent trials have shown potential benefit of extended adjuvant endocrine therapy and relatively high risk of recurrence (RoR) after 5 years in hormone receptor-positive (HR+) human epidermal growth factor receptor 2–negative (HER22) breast cancer. Although risk of late relapse in HR+ HER22 breast cancer is fairly well defined, the risk in HER2-positive (HER2+) breast cancer treated with adjuvant trastuzumab-based chemotherapy remains largely unknown. METHODS We included 3,177 patients with HER2+ breast cancer treated with adjuvant chemotherapy alone or with trastuzumab from the North Central Cancer Treatment Group N9831 (ClinicalTrials.gov identifier: NCT00005970) and National Surgical Adjuvant Breast and Bowel Project B-31 (ClinicalTrials.gov identifier: NCT00004067) trials. RESULTS Overall, HR+ breast cancer was significantly associated with improved recurrence-free survival (RFS) during the first 5 years (hazard ratio, 0.65; 95% CI, 0.56 to 0.77; P, .001). Among patients treated with trastuzumab, cumulative hazard for RFS was lower in patients with HR+ HER2+ breast cancer during the first 5 years (10.96% v 17.48%; hazard ratio, 0.60; 95% CI, 0.45 to 0.79; P, .001). However, there was no significant difference in RFS based on HR status during years 5 to 10 (hazard ratio, 1.32; 95% CI, 0.93 to 1.88; P = .12). A comparable degree of trastuzumab benefit was observed in HR+ and HR2 breast cancers (P for interaction = .87). Furthermore, we observed low RoR in years 5 to 10 among patients with HR+ HER2+ breast cancer: 3.23% in patients without lymph node involvement (N0) and 6.39% in patients with involvement of one to three lymph nodes (N1). CONCLUSION The benefit of adjuvant trastuzumab persists for a long time. A distinct pattern of recurrence was observed between HR+ and HR2 HER2+ disease but with similar degree of benefit from adjuvant trastuzumab. RoR in years 5 to 10 in HR+ HER2+ breast cancer is low, particularly in patients with N0 or N1 disease.
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U2 - 10.1200/JCO.19.00443
DO - 10.1200/JCO.19.00443
M3 - Article
C2 - 31622131
AN - SCOPUS:85076327372
SN - 0732-183X
VL - 37
SP - 3425
EP - 3435
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 35
ER -