View Full Version : San Antonio Abstract on-Significant increased recurrence rates among breast cancer ..

12-13-2008, 11:15 AM
Increased rates of relapse for her2+ bc compared to other bc subtypes could be higher in this cohort study from 1973 to 2003, a period of time when adjuvant Herceptin and chemotherapy were not used routinely for early stage bc. I believe that the statistics would be better since the testing of her2 and treating for it with chemo and Herceptin. Clearly, the article does support that fact that adjuvant chemo and herceptin is indicated for even the earliest stage her2+ bc, unlike perhaps some other bc subtypes.

PS. Ten years from now, they'll be looking at retrospective survival of her2+ bc that was treated with adjuvant herceptin and chemo and I predict those statistics will be better than the following study:

[701] Significant increased recurrence rates among breast cancer patients with HER2-positive, T1a,bN0M0 tumors.

Rakkhit R, Broglio K, Peintinger F, Cardoso F, Hanrahan EO, Litton JK, Sahin A, Larsimont D, Meric-Bernstam F, Buchholz TA, Valero V, Theriault RL, Piccart M, Ravdin P, Hortobagyi GN, Gonzalez-Angulo AM MD Anderson Cancer Center, Houston, TX; MD Anderson Cancer Center; General Hospital Leoben, Leoben, Austria; Jules Bordet Institute, Brussels, Belgium

Background: Controversy surrounds the prognosis of breast cancer patients with T1a,bN0M0 tumors following locoregional therapy and the need for adjuvant systemic therapy, especially for HER2+ disease. The purposes of the study were to determine the recurrence-free survival (RFS), and distant recurrence-free survival (DRFS) in small HER2+ tumors compared with hormone receptor ( HR)+ and triple receptor- (TN) tumors.
Methods: Stage T1a,bN0M0 breast cancers diagnosed between 1973-2003 were reviewed by dedicated breast pathologists. HER2+ tumors were defined as 3+ by IHC or gene amplification. Patients were categorized into 3 groups:TN (ER-, PR-and HER2-), HER2+ (regardless of HR status) and HR+ (HER2-). RFS and DRFS were estimated by the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards models were fit to determine the association of each group with the risk of recurrence after adjustment for other characteristics.
Results: Of the 1796 patients, 427 were excluded from the analysis due to being male (2), lack of receptor information (249), and adjuvant chemotherapy (176) leaving 1369 pts for analysis. Median age was 57 years,(range, 26-88). There were 381(28%) T1a and 988(72%) T1b tumors; HR+ 68%, TN 23%, HER2+ 9%. Patients who had HER2+ breast cancer tended to be younger,(p=0.001); have more T1a tumors, (p=0.001); and have higher nuclear grade,(p<0.001). At a median follow-up of 74 months(range 1-350), there were 160 recurrences and 77 distant metastases. Five and 10-year RFS and DRFS are summarized in the table. After adjustment for other characteristics, patients with HER2+ breast cancer had a significantly worse RFS (HR: 5.19, 95% CI: 3.21-8.39, p<0.0001) and DRFS (HR: 4.66, 95% CI: 2.47-8.80, p<0.0001) compared to patients with HR-positive breast cancer.
Conclusions: Breast cancer patients with HER2+ T1a,bN0M0 tumors have a significant risk of relapse and should be considered candidates for adjuvant systemic therapy including anti-HER2 agents.

<table width="100%" border="1"><caption>Survival Estimates</caption><tbody><tr><td>RFS</td><td>5-year</td><td>95%CI</td><td>10-year</td><td>95%CI</td><td>p-value</td></tr><tr><td>HER-2+</td><td>78.2%</td><td>(69.2%, 84.9%)</td><td>61.7%</td><td>(49.1%, 72%)</td><td>
</td></tr><tr><td>HR+</td><td>95.6%</td><td>(94%, 96.8%)</td><td>88.2%</td><td>(84.4%, 91.1%)</td><td>
</td></tr><tr><td>TN</td><td>90.4%</td><td>(86.3%, 93.3%)</td><td>80.0%</td><td>(71%, 86.4%)</td><td><.0001</td></tr><tr><td>DRFS</td><td>5-year</td><td>95%CI</td><td>10-year</td><td>95%CI</td><td>p-value</td></tr><tr><td>HER-2+</td><td>87.6%</td><td>(79.6%, 92.7%)</td><td>80.1%</td><td>(66.8%, 88.5%)</td><td>
</td></tr><tr><td>HR+</td><td>97.8%</td><td>(96.5%, 98.6%)</td><td>93.8%</td><td>(90.7%, 95.9%)</td><td>
</td></tr><tr><td>TN</td><td>95.2%</td><td>(91.8%, 97.2%)</td><td>91.9%</td><td>(85.9%, 95.4%)</td><td><.0001</td></tr></tbody></table><tfooter></tfooter>

Saturday, December 13, 2008 7:00 AM

Poster Discussion Session: HER2 as a Biomarker (7:00 AM-9:00 AM)

03-12-2009, 07:33 PM
This study is looking at the natural history of her-2/neu positive tumors less than 1cm in size with no lymph node involvement. In other words, what happens to these patients when no chemo is given. So, the statistics shown are for patients only treated with lumpectomy/xrt or mastectomy. No chemo. no herceptin.

I still think the numbers seem rather crappy. I think the data is likely questionable. First of all, going back to 1973 and reviewing charts is difficult. Also, there were likely many patients who were understaged. There were no MRI's or PET scans back then to assess the axillary nodes. I can pretty much guarantee you that many, if not all, T1a tumor patients did not have an axillary nodal dissection and sentinal biospies weren't yet being performed. So, all they had to base the nodal status on was physical exam. Well, that's just not very accurate. I wonder if some of the women were really N1 when they were called N0. We will never know.

Prospective studies are much more reliable. I like the Cleveland Clinic study much better!