The optimal schedule of anti-HER2 Tx for HER2+ ESBrCa with respect to chemotherapy and surgery remains undefined. We performed a retrospective analysis of a large, prospectively maintained single institution data base to study the impact of treatment schedule on clinical outcome.
Our database included all pts treated with T for Stage I to III HER2+BrCa who had a minimum follow up (FU) of 3 years. Time-to-first-T (TFT) was calculated from the date of the first diagnostic breast biopsy to the date of the first T. Pts with stage N3b and N3c or inoperable disease were excluded from the study.
A total of 506 pts treated between October 2001 and March 2014 were included in the study. T was administered as part of AdjTx in 386 (76%) pts, and of NAdjTx in 120 (24%), 338 (67%) pts had TCH [docetaxel/CBDCA/T] or “TCH-like”, 119 (24%) pts had delayed concomitant (i.e. AC-TH)/sequential T. Median FU is 73.3 months (range 1.4-176.3). Median TFT for the overall cohort was 12 weeks (range 1.9-122.3). Median TFT was significantly shorter in the NAdj than in the Adj cohort: 4.4 vs 14 weeks [p12 weeks, respectively [p 12 weeks had a significantly higher risk of recurrence [HR 1.96; p = 0.008] and death [HR 2.84; p = 0.006] than pts with TFT ≤12 weeks. Pts with positive lymph nodes (LN+) and TFT >12 weeks had significantly higher risk of relapse [HR 2.40, p = 0.001] and death [HR 2.10, p = 0.024] than pts with TFT ≤12 weeks. However, despite NAdj pts having significantly higher rate of LN + (75% vs 53%, p
Our mature data indicate that timing of anti-HER2 Tx significantly affects long-term outcome and T should be initiated ≤12 weeks from first diagnosis of ES HER2+BrCa. The early institution of T in the NAdj cohort abolished the negative impact of LN+, thus suggesting that this should be considered the optimal Tx strategy for ES HER2+BrCa.
Clinical trial identification
Legal entity responsible for the study
All authors have declared no conflicts of interest.