Predictors of Locoregional Outcome in HER2-Overexpressing Breast Cancer Treated with Neoadjuvant Chemotherapy

Daniel Arsenault, Judith Hurley, Cristiane Takita, Isildinha M. Reis, Wei Zhao, Steven Rodgers, Jean Wright

Research output: Contribution to journalArticle

Abstract

Objectives: We identified prognostic factors for locoregional recurrence (LRR) in a cohort of patients with HER2-overexpressing breast cancer treated with neoadjuvant chemotherapy (NACT). Methods: We reviewed records of 157 patients with HER-overexpressing tumors who received NACT between May 1999 and December 2009 and collected demographics, disease/treatment characteristics, and clinical outcome. We estimated rate of LRR by the method of cumulative incidence. Results: Presentation was 33% stage II and 67% stage III; 29.9% were clinically node positive. All patients received NACT, 94% trastuzumab containing. 90.4% had mastectomy and 6.4% breast-conserving surgery; 3.2% had no surgery. Among surgical patients, 48% were pathologically N0, 28.8% had 1 to 3 positive nodes, and 23.7% had ≥4 positive nodes. 79.6% received radiation therapy (RT) to the breast/chest wall±supraclavicular field. Median follow-up was 43 months. Three-year cumulative incidence of LRR was 8.2%; 50% of LRR had a regional component. Predictors for LRR included use of RT (HR=4.70, P=0.006), lymph node positivity (≥4 vs. 0 HR=19.99, P=0.008; 1 to 3 vs. 0 HR=10.8, P=0.031), and ER status (negative vs. positive HR=6.02, P=0.006). The only risk factor for regional failure specifically was residual nodal disease (≥4 HR=6.5, 1 to 3 HR=5.1, P=0.031). Conclusions: In a cohort with stage II to III HER2-overexpressing breast cancer treated predominantly with trastuzumab-containing NACT followed by mastectomy±RT, we identified omission of RT, negative ER status, and residual positive lymph nodes as significant predictors of LRR, with 50% of LRR having a regional component.

Original languageEnglish (US)
Pages (from-to)348-352
Number of pages5
JournalAmerican Journal of Clinical Oncology: Cancer Clinical Trials
Volume38
Issue number4
DOIs
StatePublished - Aug 6 2015
Externally publishedYes

Fingerprint

Breast Neoplasms
Recurrence
Drug Therapy
Radiotherapy
Lymph Nodes
Segmental Mastectomy
Mastectomy
Incidence
Breast
Thorax
Demography
Neoplasms
Trastuzumab
Therapeutics

Keywords

  • HER2-positive breast cancer
  • locally advanced breast cancer
  • locoregional outcome
  • neoadjuvant chemotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Medicine(all)

Cite this

Predictors of Locoregional Outcome in HER2-Overexpressing Breast Cancer Treated with Neoadjuvant Chemotherapy. / Arsenault, Daniel; Hurley, Judith; Takita, Cristiane; Reis, Isildinha M.; Zhao, Wei; Rodgers, Steven; Wright, Jean.

In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 38, No. 4, 06.08.2015, p. 348-352.

Research output: Contribution to journalArticle

Arsenault, Daniel ; Hurley, Judith ; Takita, Cristiane ; Reis, Isildinha M. ; Zhao, Wei ; Rodgers, Steven ; Wright, Jean. / Predictors of Locoregional Outcome in HER2-Overexpressing Breast Cancer Treated with Neoadjuvant Chemotherapy. In: American Journal of Clinical Oncology: Cancer Clinical Trials. 2015 ; Vol. 38, No. 4. pp. 348-352.
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abstract = "Objectives: We identified prognostic factors for locoregional recurrence (LRR) in a cohort of patients with HER2-overexpressing breast cancer treated with neoadjuvant chemotherapy (NACT). Methods: We reviewed records of 157 patients with HER-overexpressing tumors who received NACT between May 1999 and December 2009 and collected demographics, disease/treatment characteristics, and clinical outcome. We estimated rate of LRR by the method of cumulative incidence. Results: Presentation was 33{\%} stage II and 67{\%} stage III; 29.9{\%} were clinically node positive. All patients received NACT, 94{\%} trastuzumab containing. 90.4{\%} had mastectomy and 6.4{\%} breast-conserving surgery; 3.2{\%} had no surgery. Among surgical patients, 48{\%} were pathologically N0, 28.8{\%} had 1 to 3 positive nodes, and 23.7{\%} had ≥4 positive nodes. 79.6{\%} received radiation therapy (RT) to the breast/chest wall±supraclavicular field. Median follow-up was 43 months. Three-year cumulative incidence of LRR was 8.2{\%}; 50{\%} of LRR had a regional component. Predictors for LRR included use of RT (HR=4.70, P=0.006), lymph node positivity (≥4 vs. 0 HR=19.99, P=0.008; 1 to 3 vs. 0 HR=10.8, P=0.031), and ER status (negative vs. positive HR=6.02, P=0.006). The only risk factor for regional failure specifically was residual nodal disease (≥4 HR=6.5, 1 to 3 HR=5.1, P=0.031). Conclusions: In a cohort with stage II to III HER2-overexpressing breast cancer treated predominantly with trastuzumab-containing NACT followed by mastectomy±RT, we identified omission of RT, negative ER status, and residual positive lymph nodes as significant predictors of LRR, with 50{\%} of LRR having a regional component.",
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T1 - Predictors of Locoregional Outcome in HER2-Overexpressing Breast Cancer Treated with Neoadjuvant Chemotherapy

AU - Arsenault, Daniel

AU - Hurley, Judith

AU - Takita, Cristiane

AU - Reis, Isildinha M.

AU - Zhao, Wei

AU - Rodgers, Steven

AU - Wright, Jean

PY - 2015/8/6

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N2 - Objectives: We identified prognostic factors for locoregional recurrence (LRR) in a cohort of patients with HER2-overexpressing breast cancer treated with neoadjuvant chemotherapy (NACT). Methods: We reviewed records of 157 patients with HER-overexpressing tumors who received NACT between May 1999 and December 2009 and collected demographics, disease/treatment characteristics, and clinical outcome. We estimated rate of LRR by the method of cumulative incidence. Results: Presentation was 33% stage II and 67% stage III; 29.9% were clinically node positive. All patients received NACT, 94% trastuzumab containing. 90.4% had mastectomy and 6.4% breast-conserving surgery; 3.2% had no surgery. Among surgical patients, 48% were pathologically N0, 28.8% had 1 to 3 positive nodes, and 23.7% had ≥4 positive nodes. 79.6% received radiation therapy (RT) to the breast/chest wall±supraclavicular field. Median follow-up was 43 months. Three-year cumulative incidence of LRR was 8.2%; 50% of LRR had a regional component. Predictors for LRR included use of RT (HR=4.70, P=0.006), lymph node positivity (≥4 vs. 0 HR=19.99, P=0.008; 1 to 3 vs. 0 HR=10.8, P=0.031), and ER status (negative vs. positive HR=6.02, P=0.006). The only risk factor for regional failure specifically was residual nodal disease (≥4 HR=6.5, 1 to 3 HR=5.1, P=0.031). Conclusions: In a cohort with stage II to III HER2-overexpressing breast cancer treated predominantly with trastuzumab-containing NACT followed by mastectomy±RT, we identified omission of RT, negative ER status, and residual positive lymph nodes as significant predictors of LRR, with 50% of LRR having a regional component.

AB - Objectives: We identified prognostic factors for locoregional recurrence (LRR) in a cohort of patients with HER2-overexpressing breast cancer treated with neoadjuvant chemotherapy (NACT). Methods: We reviewed records of 157 patients with HER-overexpressing tumors who received NACT between May 1999 and December 2009 and collected demographics, disease/treatment characteristics, and clinical outcome. We estimated rate of LRR by the method of cumulative incidence. Results: Presentation was 33% stage II and 67% stage III; 29.9% were clinically node positive. All patients received NACT, 94% trastuzumab containing. 90.4% had mastectomy and 6.4% breast-conserving surgery; 3.2% had no surgery. Among surgical patients, 48% were pathologically N0, 28.8% had 1 to 3 positive nodes, and 23.7% had ≥4 positive nodes. 79.6% received radiation therapy (RT) to the breast/chest wall±supraclavicular field. Median follow-up was 43 months. Three-year cumulative incidence of LRR was 8.2%; 50% of LRR had a regional component. Predictors for LRR included use of RT (HR=4.70, P=0.006), lymph node positivity (≥4 vs. 0 HR=19.99, P=0.008; 1 to 3 vs. 0 HR=10.8, P=0.031), and ER status (negative vs. positive HR=6.02, P=0.006). The only risk factor for regional failure specifically was residual nodal disease (≥4 HR=6.5, 1 to 3 HR=5.1, P=0.031). Conclusions: In a cohort with stage II to III HER2-overexpressing breast cancer treated predominantly with trastuzumab-containing NACT followed by mastectomy±RT, we identified omission of RT, negative ER status, and residual positive lymph nodes as significant predictors of LRR, with 50% of LRR having a regional component.

KW - HER2-positive breast cancer

KW - locally advanced breast cancer

KW - locoregional outcome

KW - neoadjuvant chemotherapy

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