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Treatment of small node-negative HER2+ invasive breast carcinomas: Forty-month update of the joint Aerio/Remagus study.


Sub-category:
HER2+

Category:
Breast Cancer - HER2/ER

Meeting:
2011 ASCO Annual Meeting

Abstract No:
557

Citation:
J Clin Oncol 29: 2011 (suppl; abstr 557)


Attend this session at the
ASCO Annual Meeting!
Session: Breast Cancer - HER2/ER

Type: General Poster Session

Time: Monday June 6, 1:00 PM to 5:00 PM

Location: McCormick Place Hall A



Author(s): J. Wassermann, L. Albiges, M. J. Rodrigues, E. Brain, S. Delaloge, J. Guinebretiere, M. C. Mathieu, E. Guillot, A. Vincent-Salomon, P. H. Cottu, AERIO/REMAGUS; Institut Curie - Centre René Huguenin, Saint-Cloud, France; Institut Gustave Roussy, Villejuif, France; Institut Curie, Paris, France; Institut Gustave-Roussy, Villejuif, France; Institut Curie-Hôpital René Huguenin, Saint-Cloud, France


Abstract Disclosures


Abstract:

Background: Trials have shown benefit of adjuvant trastuzumab (TZM) for N+ or supra-centrimetric HER2+ breast carcinomas. Methods: Retrospective multicenter series from 2000 to 2008 of infra-centimetric HER2+ invasive breast carcinomas (InfraHER2) non metastatic. Tumors with ≥80% of carcinoma in situ, multifocal and metastatic tumors were excluded. Results: 97 cases have been evaluated. Median age was 55 years (24 to 87 years). 67% were discovered by systematic breast cancer screening with no significative difference between T1a and T1b (79% vs 64%, Fisher’s exact test p=0.23). Median size was 8 mm (range, 2 to 10 mm), 22 were T1a, 75 tumors were T1b. Fifty-one tumors (53%) exhibited significant HR expression. All patients had surgery. 57% (n=55) had a sentinel lymph node procedure. 68% (n=66) had a local irradiation and 44 patients (71% of those who had undergone breast conservative surgery) a tumor bed boost. 42/51 HR+ patients received hormonotherapy (82%): 21 received aromatase inhibitors (AI) upfront or sequential, 9 received tamoxifen (TAM) alone, 11 received LHRH agonists alone or in combination with TAM or AI. 43% (n=42) had chemotherapy (CT), (Anthracycline alone for 20 cases, taxane for 2 cases, sequential A/T for 19 cases and concurrent for 1 case) almost all (37) were associated to TZM. In three cases, TZM was administered without chemotherapy. Decision of adjuvant CT was associated (all p<0.05) with hormonal receptors (HR) negative status, Elston-Ellis grade (EE) 2/3 and high mitotic index (MI) while patients with HR+/low MI tumors were rarely treated (p<0.001). With a 41 months median follow-up, there was no invasive recurrence in TZM group and 8 of the 56 patients treated without TZM had a recurrent invasive disease including three fatal. Difference in recurrence between TZM treated patients and others was statistically significant (40-months Kaplan-Meier cumulative risk: 100% vs 89%; log-rank p=0.02). Conclusions: In our practice N- InfraHER2 tumors may have a significant risk of recurrence which could be avoided by chemo-trastuzumab-based adjuvant treatment. Patients with N- InfraHER2 tumors should be included in HER2-targeted adjuvant trials.