Local-regional recurrence in women with small node-negative, HER2-positive breast cancer: results from a prospective multi-institutional study (the APT trial).

Authors:
Jennifer R Bellon
Jennifer R Bellon
Harvard Medical School
United States
Hao Guo
Hao Guo
Fudan University
China
William T Barry
William T Barry
Duke University Medical Center
United States
Chau T Dang
Chau T Dang
McMaster University/Hamilton Regional Cancer Center
Canada
Denise A Yardley
Denise A Yardley
Sarah Cannon Research Institute
United States
Beverly Moy
Beverly Moy
Massachusetts General Hospital
United States
Kathy S Albain
Kathy S Albain
Loyola University Chicago Stritch School of Medicine
United States

Breast Cancer Res Treat 2019 Apr 19. Epub 2019 Apr 19.

Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.

Purpose: Women with HER2-positive breast cancer treated prior to effective anti-HER2 therapy have higher rates of local-regional recurrence (LRR) than those with HER2-negative disease. Effective systemic therapy, however, has been shown to decrease LRR. This study examines LRR in women with HER2-positive breast cancer treated on a single-arm prospective multicenter trial of adjuvant trastuzumab (H) and paclitaxel (T).

Methods: Patients with HER2-positive tumors ≤ 3.0 cm with negative axillary nodes or micrometastatic disease were eligible. Systemic therapy included weekly T and H for 12 weeks followed by continuation of H to complete 1 year. Radiation therapy (RT) was required following breast-conserving surgery (BCS), but dose and fields were not specified. Disease-free survival (DFS) and LRR-free survival were calculated using the Kaplan-Meier method.

Results: Of the 410 patients enrolled from September 2007 to September 2010, 406 initiated protocol therapy and formed the basis of this analysis. A total of 272 (67%) had hormone receptor-positive tumors. Of 162 patients undergoing mastectomy, local therapy records were unavailable for two. None of the 160 for whom records were available received RT. Among 244 BCS patients, detailed RT records were available for 217 (89%). With a median follow-up of 6.5 years, 7-year DFS was 93.3% (95% CI 90.4-96.2), and LRR-free survival was 98.6% (95% CI 97.4-99.8).

Conclusion: LRR in this select group of early-stage patients with HER2-positive disease receiving effective anti-HER2 therapy is extremely low. If confirmed in additional studies, future investigational efforts should focus on de-escalating local therapy.

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http://link.springer.com/10.1007/s10549-019-05238-4
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http://dx.doi.org/10.1007/s10549-019-05238-4DOI Listing
April 2019
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