Adjuvant Trastuzumab dramatically reduces the risk of relapse for Her2 positive breast cancer patients (BCP). However, in middle income countries, such as Romania (Ro) and Argentina (Ar), the treatment of HER2 + BCP remains under the constraints of health care resources and poses unique challenges due to lack of resources. The aim of this work is to compare time of initiation of Trastuzumab (TIT) in HER2 + BCP and its correlation with clinical outcome at 5 years in two medical centers: Institute of Oncology "Ion Chiricuta" Cluj-Napoca [Ro] and Hospital Italiano de Rosario [Ar].
This was an observational, retrospective study based on medical records of primary BCP (Hormone receptor [HR], Her2/Neu+) and included 43 patients (n = Ar: 25; Ro: 18) with at least 5 years of follow up from both institutions. According to their clinical outcome (CO) at 5 years of the primary treatment, each patient was classified in two primary groups: disease free or relapsed.
Mean age of patients was 54 (range: 33-91) and mean stage of disease was II (range: I-III). Nonstatistical differences according to age and disease stage were found between groups. The most frequent histology was ductal invasive carcinoma (Ar: 12/25; Ro: 18/18; p = 0.007).All patients received surgery as primary treatment. Fourteen (14) patients received neo-adjuvant treatment (Ar: 7/25; Ro: 7/18; p = 0.167) and twenty two (22) patients received radiotherapy (Ar: 18/25; Ro: 4/18; p = 0.002). Most patients received adjuvant chemotherapy based on anthracyclines schemes (p = 0.139) and all patients received Trastuzumab. Median TIT was 8 months (range: 2-18) [Ar: 7 (range: 2-17); Ro: 11 (range: 4-18), p = 0.001]. At 5 years of follow-up 18 patients relapsed (Ar: 8/25; Ro: 10/18; p = 0.148). There were no association between CO and TIT in both group of patients.
The delay on initiation of Trastuzumab, in our limited series, did not prove to interfere in the risk of relapse in HR-HER2 + BCP. Larger studies are needed to address this issue.
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Institute of Experimental Genetics, National University of Rosario, Argentina; Italian Hospital of Rosario, Argentina; and Institute of Oncology "Ion Chiricuta" Cluj-Napoca, Romania.
All authors have declared no conflicts of interest.