Real-World Outcomes of Adjuvant Chemotherapy for Node-Negative and Node-Positive HER2-Positive Breast Cancer

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  • a Princess Margaret Cancer Centre, Toronto, Ontario; Tom Baker Cancer Centre, Calgary, Alberta; CancerControl Alberta, Alberta Health Services, Calgary, Alberta; and Cross Cancer Institute, Edmonton, Alberta, Canada.
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Background: Comparative real-world outcomes for patients with HER2-positive (HER2+) breast cancer receiving adjuvant trastuzumab outside of clinical trials are lacking. This study sought to retrospectively characterize outcomes for patients with node-negative and node-positive breast cancer receiving adjuvant trastuzumab in combination with docetaxel/cyclophosphamide (DCH), docetaxel/carboplatin/trastuzumab (TCH), or fluorouracil/epirubicin/cyclophosphamide followed by docetaxel/trastuzumab (FEC-DH) chemotherapy in Alberta, Canada, from 2007 through 2014. Methods: Disease-free survival and overall survival (OS) analyses for node-negative cohorts receiving DCH (n=111) or TCH (n=371) and node-positive cohorts receiving FEC-DH (n=146) or TCH (n=315) were compared using chi-square, Kaplan-Meier, or Cox multivariable analysis where appropriate. Results: Median follow-up was similar in node-negative (63.9 months) and node-positive (69.0 months) cohorts. The 5-year OS rates in patients with node-negative disease receiving DCH or TCH were similar (95.2% vs 96.9%; P=.268), whereas 5-year OS rates were higher but nonsignificant for patients with node-positive disease treated with FEC-DH compared with TCH (95.2% vs 91.4%; P=.160). Subgroup analysis of node-positive cohorts showed significantly improved OS with FEC-DH versus TCH in patients with estrogen receptor (ER)/progesterone receptor (PR)–positive breast cancer (98.3% vs 91.6%, respectively; P=.014). Conversely, patients with ER/PR-negative disease showed a nonsignificant trend toward higher OS rates with TCH versus FEC-DH (91.6% vs 83.3%, respectively; P=.298). Given the retrospective design, we were unable to capture all potential covariates that may have impacted treatment assignment and/or outcomes. Furthermore, cardiac toxicity data were unavailable. Conclusions: Survival rates of patients with HER2+ breast cancer in our study are comparable to those seen in clinical trials. Our findings support chemotherapy de-escalation in patients with node-negative disease and validate the efficacy of FEC-DH in those with node-positive disease.

Author contributions: Study concept: Veitch, King, Tang, Lupichuk. Data acquisition: Veitch, Khan. Oversight and coordination of data management: Kostaras. Data cleaning: Veitch, Tilley. Data analysis: Tilley, Kostaras. Data interpretation: Veitch, Tilley, Ribnikar, Kostaras, King, Tang, Lupichuk. Manuscript preparation: Veitch, Kostaras. Manuscript editing: Khan, Tilley, Ribnikar, King, Tang, Lupichuk. Final approval: Veitch, Lupichuk.

Correspondence: Sasha Lupichuk, MD, MSc, Department of Oncology, Tom Baker Cancer Centre, 1331 29th Street NW, Calgary, AB Canada T2N4N2. Email: Sasha.Lupichuk@AHS.ca

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