Journal Article

Real-World Impact of Adjuvant Anti-HER2 Treatment on Characteristics and Outcomes of Women With HER2-Positive Metastatic Breast Cancer in the ESME Program

Le Du, Fanny, Desmoulins, Isabelle, Bachelot, Thomas, Delaloge, Suzette, Brain, Etienne, Uwer, Lionel, Jacot, William, Vermeulin, Thomas, Saghatchian, Mahasti, Emile, George, Vanlemmens, Laurence, Carton, Matthieu, Pistilli, Barbara, Gonçalves, Anthony, Marc Ferrero, Jean, Ung, Mony, Chevrot, Michaël, Jaffre, Anne, Robert, Marie, Jouannaud, Christelle, Loirat, Delphine, Diéras, Véronique, Mouret-Reynier, Marie-Ange

2023

Overview

Abstract Background Although adjuvant cancer treatments increase cure rates, they may induce clonal selection and tumor resistance. Information still lacks as whether (neo)adjuvant anti-HER2 treatments impact the patterns of recurrence and outcomes of HER2-positive (HER2+) metastatic breast cancer (MBC). We aimed to assess this in the large multicenter ESME real-world database. Patients and Methods We examined the characteristics and outcomes (overall survival (OS) and progression-free survival under first-line treatment (PFS1)) of HER2+ patients with MBC from the French ESME program with recurrent disease, as a function of the previous receipt of adjuvant trastuzumab. Multivariable analyses used Cox models adjusted for baseline demographic, prognostic factors, adjuvant treatment received, and disease-free interval. Results Two thousand one hundred and forty-three patients who entered the ESME cohort between 2008 and 2017 had a recurrent HER2+ MBC. Among them, 56% had received (neo)adjuvant trastuzumab and 2.5% another anti-HER2 in this setting. Patients pre-exposed to trastuzumab were younger, had a lower disease-free interval, more HR-negative disease and more metastatic sites. While the crude median OS appeared inferior in patients exposed to adjuvant trastuzumab, as compared to those who did not (37.2 (95%CI 34.4-40.3) versus 53.5 months (95% CI: 47.6-60.1)), this difference disappeared in the multivariable model (HR = 1.05, 95%CI 0.91-1.22). The same figures were observed for PFS1. Conclusions Among patients with relapsed HER2+ MBC, the receipt of adjuvant trastuzumab did not independently predict for worse outcomes when adjusted to other prognostic factors. There is limited real-world information on the impact of adjuvant and neoadjuvant anti-HER2-targeted treatments on patterns of recurrence and outcomes of patients with HER2+ metastatic breast cancer. This article reports on how anti-HER2 targeted treatment in the early setting impacts overall and progression-free survival under first-line treatment of patients with metastatic HER2+ breast cancer.

• Publisher: Oxford University Press
• Subject: Adjuvant treatment / Breast Cancer / Cancer / Care and treatment / Development and progression / Diagnosis / Life Sciences / Medical prognosis / Metastasis / Pertuzumab / Pharmaceutical industry