Locoregional Recurrence Rates among HER2-Positive Patients from 2003-2015: A Retrospective Review
Grace Hendrickson1, Gaurav Ajmani1, Catherine Pesce1, Ermilo Barrera1, David J. Winchester1, Katharine Yao1
1Department of Surgery, NorthShore University HealthSystem
RESULTS
BACKGROUND
Table 1. Patient Characteristics
In the early 2000s, treatment with Herceptin
(trastuzumab) became the standard of care for
patients with human epidermal growth factor
receptor 2 (HER2)-positive breast cancer based on
several randomized trials that demonstrated
improved overall survival for those patients who
receive Herceptin compared to those who did not
receive Herceptin. However, few studies have
examined locoregional recurrence (LRR) among
HER2-positive patients and how these rates vary by
patient, tumor factors, and surgery type, especially
after neoadjuvant therapy.
OBJECTIVE
To examine LRR rates among HER2positive breast cancer patients treated with
neoadjuvant Herceptin, adjuvant
Herceptin, or no Herceptin.
METHODS
•544 female, HER2-positive breast cancer patients
identified from an institutional database
•Diagnosed from 2003-2015
•3 cohorts:
-Neoadjuvant Herceptin (3 yr f/u)
-Adjuvant Herceptin (5.4 yr f/u)
-No Herceptin (7.2 yr f/u)
•Local recurrence and regional nodal recurrence
examined between the three groups
•LRR stratified by age, race, hormone receptor (HR)
status, stage of disease, nodal status, surgery type,
radiation given, and hormone therapy given
REFERENCES
Piccart-Gebhart MJ, Procter M, Leyland-Jones B, et. al. Trastuzumab after Adjuvant Chemotherapy in HER2-Positive Breast
Cancer. N Engl J of Med 2005; 16:1659-72.
The Breast Cancer Deadline 2020 (2013). Trastuzumab. Available: http://www.breastcancerdeadline2020.org/breast-cancerinformation/specific-issues-in-breast-cancer/trastuzumab/ [accessed March 28, 2017].
Peterson DJ, Truong PT, Sadek BT, et. al. Locoregional Recurrence and Survival Outcomes by Type of Local Therapy and
Trastuzumab Use among Women with Node-Negative, Her2-Positive Breast Cancer. Ann Surg Oncol 2014; 11:3490-6.
Kiess AP, McArthur HL, Mahoney K, et. al. Adjuvant Trastuzumab Reduces Locoregional Recurrence in Women who
Receive Breast-Conservation Therapy for Lymph Node-Negative, Human Epidermal Growth Factor Receptor 2–Positive
Breast Cancer. Cancer 2012; 118:1982-8.
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. Ann Surg Oncol 2015; 8;2517-25.
National Cancer Institute (2013). FDA Approval for Pertuzumab. Available: https://www.cancer.gov/aboutcancer/treatment/drugs/fda-pertuzumab [accessed March 28, 2017].
LIMITATIONS
Table 2. LRR Rates by Herceptin Treatment
No
All Patients
Herceptin
Total
Patients
LRR
544
157
(28.9%)
Neoadjuvant Adjuvant
116 (21.3%)
271
(49.8%)
p-value
p-value
p-value
Neoadjuvant No Herceptin No Herceptin
vs.
vs. Adjuvant vs. Adjuvant
Neoadjuvant
38 (7.0%)
17 (10.8%)
8 (6.9%)
13 (4.8%)
0.4036
0.0185
0.2959
Breast
19 (3.5%)
10 (6.4%)
2 (1.7%)
7 (2.6%)
0.6075
0.0710
0.0773
Nodal
19 (3.5%)
7 (4.5%)
6 (5.2%)
6 (2.2%)
0.1240
0.2436
0.7821
Table 3. LRR in patients that received no Herceptin versus patients that received adjuvant Herceptin
•Single-institution, retrospective study
•Small sample size
•Short follow up
SUMMARY
•LRR rates were approximately 5.0% in adjuvant
Herceptin patients and 7.0% in neoadjuvant
Herceptin patients compared to 11% in the no
Herceptin cohort.
•LRR occurred significantly more often in the no
Herceptin cohort than in the adjuvant Herceptin
cohort, but LRR rates between the neoadjuvant
and adjuvant Herceptin cohorts were not different.
•LRR occurred more often in the breast than in
the lymph nodes for the adjuvant Herceptin cohort
compared to the neoadjuvant Herceptin cohort.
•LRR rates were not different between
lumpectomy and mastectomy patients undergoing
adjuvant Herceptin.
•LRR rates were different between adjuvant
Herceptin patients who received hormone therapy
and those who did not receive hormone therapy.
CONCLUSION
•Less than 10% LRR rate among all subgroups
that received adjuvant or neoadjuvant Herceptin
•Further research with longer follow up is
necessary to examine LRR in patients undergoing
neoadjuvant Herceptin compared to adjuvant
Herceptin.
•LRR should not influence patients’ surgical
decisions since rates were not different between
those that underwent lumpectomy versus
mastectomy.