靶向治疗对HER-2阳性改良根治术后未放疗乳腺癌患者复发影响——单中心大宗病例倾向评分匹配回顾分析

doi:10.3760/cma.j.issn.1004-4221.2019.11.007

Abstract
Figure/Table
References()
Related Citation (1)
Read Tracking
Download Tracking

Download: PDF (0 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective To investigate the locoregional benefit from adjuvant anti-HER-2 target therapy and the possibility of omitting postmastectomy radiation therapy (PMRT) in HER-2 positive breast cancer patients. Methods Clinical data of 1398 patients diagnosed with HER-2+ breast cancer admitted to our hospital who underwent mastectomy without PMRT from 2009 to 2014 were retrospectively analyzed, and 370 of them received adjuvant anti-HER-2 target therapy mainly with trastuzumab. Results Anti-HER-2 target therapy significantly improved the disease-free survival (DFS) and overall survival (OS), whereas reduced the locoregional recurrence (LRR) insignificantly. Multivariate analysis demonstrated that anti-HER-2 target therapy improved the locoregional recurrence-free survival (LRRFS)(P=0.06). After propensity score matching,the 5-year LRR rate was 4.4% vs. 6.4%(P=0.070) for those treated with and without anti-HER-2 target therapy. Subgroup analysis revealed that the locoregional control benefit was only significant in patients with pathological Grade Ⅰ-Ⅱtumors (2.5% vs. 5.9%,P=0.046). For patients with pN1 tumors with and without anti-HER-2 target therapy,the 5-year LRR rate was 8.2% vs. 12.3%(P=0.150). Patients with hormone receptor-positive tumors obtained significant benefit from anti-HER-2 target therapy. The 5-year LRR rate could be less than 5% in patients with favorable risk factors who received anti-HER-2 target therapy. Conclusions Anti-HER-2 target therapy with trastuzumab can improve the LRRFS of patients with HER-2+ breast cancer after mastectomy. Nevertheless, patients with radiotherapy indications have to receive radiotherapy due to relatively high recurrence rate. Newly approved dual HER-2 blockade is a promising approach to further reduce LRR. Subgroup analysis is required to identify the low-risk patients.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	Jing Hao
	Wang Shulian
	Tang Yu
	Song Yongwen
	Fang Hui
	Wang Jianyang
	Zhang Jianghu
	Jin Jing
	Liu Yueping
	Qi Shunan
	Tang Yuan
	Li Ning
	Chen Bo
	Lu Ningning
	Li Yexiong

Key words： Breast neoplasm/target therapy HER-2 gene Locoregional recurrence Locoregional recurrence-free survival

Received: 13 December 2018

Fund:National Key Research and Development Program (2016YFC0904600);Capital Clinical Features Application Research (Z171100001017116)

Corresponding Authors: Tang Yu,Email:tangyu_cams@163.com;Wang Shulian,Email:wangshulian@sohu.com

Cite this article:

Jing Hao,Wang Shulian,Tang Yu et al. Adjuvant trastuzumab reduces locoregional recurrence in women who underwent mastectomy without radiation therapy for HER-2-positive breast cancer:a retrospective analysis with propensity score matching[J]. Chinese Journal of Radiation Oncology, 2019, 28(11): 830-835.

URL:

http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.issn.1004-4221.2019.11.007 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2019/V28/I11/830

[1] Horio A,Fujita T,Hayashi H,et al. High recurrence risk and use of adjuvant trastuzumab in patients with small,HER2-positive,node-negative breast cancers[J]. Int J Clin Oncol,2012,17(2):131-136. DOI:10.1007/s10147-011-0269-4.
[2] Perez EA,Romond EH,Suman VJ,et al. Trastuzumab plus adjuvant chemotherapy for human epidermal growth factor receptor 2-positive breast cancer:planned joint analysis of overall survival from NSABP B-31 and NCCTG N9831[J]. J Clin Oncol,2014,32(33):3744-3752. DOI:10.1200/JCO.2014.55.5730.
[3] Slamon D,Eiermann W,Robert N,et al. Adjuvant trastuzumab in HER2-positive breast cancer[J]. N Engl J Med,2011,365(14):1273-1283. DOI:10.1056/NEJMoa0910383.
[4] Cameron D,Piccart-Gebhart MJ,Gelber RD,et al.11 years′ follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive early breast cancer:final analysis of the HERceptin adjuvant (HERA) trial[J]. Lancet,2017,389(10075):1195-1205. DOI:10.1016/S0140-6736(16)32616-2.
[5] Moo TA,McMillan R,Lee M,et al. Impact of molecular subtype on locoregional recurrence in mastectomy patients with T1-T2 breast cancer and 1-3 positive lymph nodes[J]. Ann Surg Oncol,2014,21(5):1569-1574. DOI:10.1245/s10434-014-3488-x.
[6] Clarke M,Collins R,Darby S,et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival:an overview of the randomised trials[J]. Lancet,2005,366(9503):2087-2106. DOI:10.1016/S0140-6736(05)67887-7.
[7] Tognela A,Beith J,Kiely B,et al. Small HER2-positive breast cancer:should size affect adjuvant treatment?[J]. Clin Breast Cancer,2015,15(4):277-284. DOI:10.1016/j.clbc.2014.12.012.
[8] Yu JI,Park W,Huh SJ,et al. Determining which patients require irradiation of the supraclavicular nodal area after surgery for N1 breast cancer[J]. Int J Radiat Oncol Biol Phys,2010,78(4):1135-1141. DOI:10.1016/j.ijrobp.2009.09.037.
[9] EBCTCG,McGale P,Taylor C,et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality:meta-analysis of individual patient data for 8135 women in 22 randomised trials[J]. Lancet,2014,383(9935):2127-2135. DOI:10.1016/S0140-6736(14)60488-8.
[10] Whelan TJ,Olivotto IA,Parulekar WR,et al. Regional Nodal Irradiation in Early-Stage Breast Cancer[J]. N Engl J Med,2015,373(4):307-316. DOI:10.1056/NEJMoa1415340.
[11] Lanning RM,Morrow M,Riaz N,et al. The effect of adjuvant trastuzumab on locoregional recurrence of human epidermal growth factor receptor 2-positive breast cancer treated with mastectomy[J]. Ann Surg Oncol,2015,22(8):2517-2525. DOI:10.1245/s10434-014-4321-2.
[12] Tseng YD,Uno H,Hughes ME,et al. Biological subtype predicts risk of locoregional recurrence after mastectomy and impact of postmastectomy radiation in a large national database[J]. Int J Radiat Oncol Biol Phys,2015,93(3):622-630. DOI:10.1016/j.ijrobp.2015.07.006.
[13] Brollo J,Kneubil MC,Botteri E,et al. Locoregional recurrence in patients with HER2 positive breast cancer[J]. Breast,2013,22(5):856-862. DOI:10.1016/j.breast.2013.03.010.
[14] Gingras I,Holmes E,De Azambuja E,et al. Regional nodal irradiation after breast conserving surgery for early HER2-positive breast cancer:results of a subanalysis from the ALTTO trial[J]. J Natl Cancer Inst,2017,109(8). DOI:10.1093/jnci/djw331.
[15] Mignot F,Ajgal Z,Xu H,et al. Concurrent administration of anti-HER2 therapy and radiotherapy:Systematic review[J]. Radiother Oncol,2017,124(2):190-199. DOI:10.1016/j.radonc.2017.07.006.
[16] Hsu JL,Hung MC. The role of HER2,EGFR,and other receptor tyrosine kinases in breast cancer[J]. Cancer Metast Rev,2016,35(4):575-588. DOI:10.1007/s10555-016-9649-6.
[17] Vanpouille-Box C,Alard A,Aryankalayil MJ,et al. DNA exonuclease Trex1 regulates radiotherapy-induced tumour immunogenicity[J]. Nat Commun,2017,8:15618. DOI:10.1038/ncomms15618.
[18] Untch M,Rezai M,Loibl S,et al. Neoadjuvant treatment with trastuzumab in HER2-positive breast cancer:results from the GeparQuattro study[J]. J Clin Oncol,2010,28(12):2024-2031. DOI:10.1200/JCO.2009.23.8451.
[19] Untch M,von Minckwitz G,Gerber B,et al. Survival analysis after neoadjuvant chemotherapy with trastuzumab or lapatinib in patients with human epidermal growth factor receptor 2-positive breast cancer in the GeparQuinto (G5) study (GBG 44)[J]. J Clin Oncol,2018,36(13):1308-1316. DOI:10.1200/JCO.2017.75.9175.
[20] Arsenault D,Hurley J,Takita C,et al. Predictors of locoregional outcome in HER2-overexpressing breast cancer treated with neoadjuvant chemotherapy[J]. Am J Clin Oncol,2015,38(4):348-352. DOI:10.1097/COC.0b013e31829d1eb8.
[21] Kim MM,Dawood S,Allen P,et al. Hormone receptor status influences the locoregional benefit of trastuzumab in patients with nonmetastatic breast cancer[J]. Cancer,2012,118(20):4936-4943. DOI:10.1002/cncr.27502.
[22] Zucali R,Mariani L,Marubini E,et al. Early breast cancer:evaluation of the prognostic role of the site of the primary tumor[J]. J Clin Oncol,1998,16(4):1363-1366. DOI:10.1200/JCO.1998.16.4.1363.
[23] Xue C,Peng RJ,Wang SS,et al. Operable breast cancer of the inner hemisphere is associated with poor survival[J]. J Breast Cancer,2015,18(1):36-43. DOI:10.4048/jbc.2015.18.1.36.
[24] Chang JH,Jeon W,Kim K,et al. Prognostic significance of inner quadrant involvement in breast cancer treated with neoadjuvant chemotherapy[J]. J Breast Cancer,2016,19(4):394-401. DOI:10.4048/jbc.2016.19.4.394.