Real-life analysis of neoadjuvant-therapy-associated benefits for pathological complete response and survival in early breast cancer patients - role of trastuzumab in HER2+ BC and platinum in TNBC

Wei-Pang Chung; Chun-Ting Yang; Shuen-Ru Yang; Ching-Yen Su; Hsin-Wei Su; Shang-Yun Liu; Huang-Tz Ou

doi:10.3389/fonc.2022.1022994

Real-life analysis of neoadjuvant-therapy-associated benefits for pathological complete response and survival in early breast cancer patients - role of trastuzumab in HER2+ BC and platinum in TNBC

Front Oncol. 2023 Jan 24:12:1022994. doi: 10.3389/fonc.2022.1022994. eCollection 2022.

Authors

Wei-Pang Chung^{1

2}, Chun-Ting Yang³, Shuen-Ru Yang¹, Ching-Yen Su⁴, Hsin-Wei Su⁴, Shang-Yun Liu⁴, Huang-Tz Ou^{3

5}

Affiliations

¹ Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Center of Applied Nanomedicine, National Cheng Kung University, Tainan, Taiwan.
³ Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴ Medical Division, Roche Products Ltd., Taipei, Taiwan.
⁵ Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Abstract

Background: Neoadjuvant therapy, which aims to achieve a pathological complete response (pCR) for better overall survival (OS) has several advantages for patients with early breast cancer (eBC) and subtypes of HER2-positive (HER2+) and triple-negative breast cancer (TNBC). However, there has been no large-scale real-world investigation on the clinical outcomes associated with trastuzumab-based and platinum-based neoadjuvant treatments for patients with HER2+ and TNBC, respectively.

Material and methods: Taiwan Cancer Registry and National Health Insurance Research Database were utilized in this study. Patients diagnosed with clinically lymph-node-positive (LN+) HER2+ or TNBC were identified for analysis. Logistic regression and Cox proportional hazard models were employed to estimate the adjusted odds ratios (aOR) of achieving pCR and adjusted hazard ratios (aHR) of overall survival associated with treatment agents, respectively.

Results: A total of 1,178 HER2+ eBC and 354 early TNBC patients were identified, respectively. Neoadjuvant trastuzumab significantly increased the pCR rates by 3.87-fold among HER2+ patients. Trastuzumab-associated survival benefit was found in HER2+ patients who achieved pCR (aHR [95% CI]: 0.30 [0.11-0.84]) but not in those without pCR (1.13 [0.77-1.67]). Among the TNBC patients, platinum was associated with a 1.6-fold increased pCR rate; however, it did not improve OS regardless of pCR status.

Conclusions: Trastuzumab improved pCR and OS for patients with HER2+ subtype. Using platinum agents for TNBC patients increased pCR rates but was not linked to better survival. Optimal neoadjuvant anti-HER2 therapy for patients with HER2+ eBC and the introduction of novel therapy for patients with TNBC should be considered.

Keywords: HER2-positive breast cancer; early breast cancer; neoadjuvant therapy; platinum; trastuzumab; triple-negative breast cancer.

Grants and funding

This project was supported by grants from the Ministry of Science and Technology in Taiwan (grant MOST 109-2320 B-006 -047-MY3) and Roche Products Ltd, Taiwan (recipient: H-TO).