What question did this study set out to answer?

To identify clinical factors associated with distant recurrence in HER2+ breast cancer patients who achieved pathological complete response after neoadjuvant therapy.

May 24, 2026Open Access

299P Clinical factors associated with distant recurrence of HER2+ breast cancer following pathological complete response to neoadjuvant therapy

Puntos clave

To identify clinical factors associated with distant recurrence in HER2+ breast cancer patients who achieved pathological complete response after neoadjuvant therapy.
Included 267 patients diagnosed with HER2+ early breast cancer treated with neoadjuvant docetaxel, carboplatin, pertuzumab, and trastuzumab.
Analyzed associations using Kaplan-Meier method, log rank test, and univariate Cox regression for hazard ratios.
Conducted Fisher's exact test to assess presence of brain metastases at the time of distant recurrence.
22 distant recurrence events were observed, with 5% in pCR patients and 13% in non-pCR patients (HR 3.56, 95% CI 1.60-7.91, p = 0.002).
Clinical stage was significantly associated with distant recurrence, especially stage 3 vs stage 1-2 (19% vs 2%).
63% of patients with pCR who experienced distant recurrence had brain metastases.

Resumen

Background:In human epidermal growth factor receptor 2 positive (HER2+) early breast cancer (EBC), lack of pathological complete response (pCR) to neoadjuvant therapy is associated with inferior prognosis.Despite pCR, some patients suffer distant relapse and predictive biomarkers are needed to identify them, as they may benefit from treatment escalation.We assessed clinical factors associated with distant recurrence (DR) following pCR in patients treated with neoadjuvant docetaxel, carboplatin, pertuzumab and trastuzumab (TCPH).Methods: Patients diagnosed with HER2+ EBC between 01/12/16-01/12/21 treated with neoadjuvant TCPH at The Christie Hospital were included.Data were collected from electronic case records.Association between age, body mass index, tumour/ nodal/overall clinical stage, tumour grade, dose intensity (85%), oestrogen receptor status, nodal fibrosis and distant recurrence free survival (DRFS) in those who achieved a pCR was analysed using Kaplan-Meier method and log rank test.Univariate cox regression was used to estimate hazard ratios (HR) and Bonferroni correction applied such that p < 0.006 was significant.Fisher's exact test was used to assess association between pCR and presence of brain metastases (BM) at time of DR.Results: 267 patients were included (median age 54, range 25-74) with a median follow up of 73 months.159 (60%) achieved pCR.There were 22 DR events, 8/159 (5%) in those with pCR and 14/108 (13%) in those without.Clinical stage was the only factor significantly associated with DR following pCR.6/32 (19%) with stage 3 disease experienced DR versus 2/127 (2%) with stage 1-2 EBC (HR 3.56, 95% CI 1.60-7.91,p = 0.002).Median DRFS was not reached in either group.BM were present at the point of DR in 5/8 (63%) of those with pCR and 6/14 (43%) of those with residual disease (p = 0.659).Conclusions: Patients with stage 3 HER2+ EBC at presentation have a high risk of relapse, even after neoadjuvant therapy and pCR.More than half relapse with BM and such patients may benefit from intensified neoadjuvant or adjuvant therapy with modern CNS penetrant regimens.Clinical trials should be considered to answer this question.

Me gusta

Guardar

Ver artículo completo