Seven-year follow-up analysis of adjuvant paclitaxel and trastuzumab trial for node-negative, human epidermal growth factor receptor 2-positive breast cancer Journal Article


Authors: Tolaney, S. M.; Guo, H.; Pernas, S.; Barry, W. T.; Dillon, D. A.; Ritterhouse, L.; Schneider, B. P.; Shen, F.; Fuhrman, K.; Baltay, M.; Dang, C. T.; Yardley, D. A.; Moy, B.; Marcom, P. K.; Albain, K. S.; Rugo, H. S.; Ellis, M. J.; Shapira, I.; Wolff, A. C.; Carey, L. A.; Overmoyer, B.; Partridge, A. H.; Hudis, C. A.; Krop, I. E.; Burstein, H. J.; Winer, E. P.
Article Title: Seven-year follow-up analysis of adjuvant paclitaxel and trastuzumab trial for node-negative, human epidermal growth factor receptor 2-positive breast cancer
Abstract: PURPOSEThe Adjuvant Paclitaxel and Trastuzumab trial was designed to address treatment of patients with small human epidermal growth factor receptor 2 (HER2)-positive breast cancer. The primary analysis of the Adjuvant Paclitaxel and Trastuzumab trial demonstrated a 3-year disease-free survival (DFS) of 98.7%. In this planned secondary analysis, we report longer-term outcomes and exploratory results to characterize the biology of small HER2-positive tumors and genetic factors that may predispose to paclitaxel-induced peripheral neuropathy (TIPN).PATIENTS AND METHODSIn this phase II study, patients with HER2-positive breast cancer with tumors 3 cm or smaller and negative nodes received paclitaxel (80 mg/m(2)) with trastuzumab for 12 weeks, followed by trastuzumab for 9 months. The primary end point was DFS. Recurrence-free interval (RFI), breast cancer-specific survival, and overall survival (OS) were also analyzed. In an exploratory analysis, intrinsic subtyping by PAM50 (Prosigna) and calculation of the risk of recurrence score were performed on the nCounter analysis system on archival tissue. Genotyping was performed to investigate TIPN.RESULTSA total of 410 patients were enrolled from October 2007 to September 2010. After a median follow-up of 6.5 years, there were 23 DFS events. The 7-year DFS was 93% (95% CI, 90.4 to 96.2) with four (1.0%) distant recurrences, 7-year OS was 95% (95% CI, 92.4 to 97.7), and 7-year RFI was 97.5% (95% CI, 95.9 to 99.1). PAM50 analyses (n = 278) showed that most tumors were HER2-enriched (66%), followed by luminal B (14%), luminal A (13%), and basal-like (8%). Genotyping (n = 230) identified one single-nucleotide polymorphism, rs3012437, associated with an increased risk of TIPN in patients with grade 2 or greater TIPN (10.4%).CONCLUSIONWith longer follow-up, adjuvant paclitaxel and trastuzumab is associated with excellent long-term outcomes. Distribution of PAM50 intrinsic subtypes in small HER2-positive tumors is similar to that previously reported for larger tumors.
Keywords: chemotherapy; score; distant recurrence; pam50 risk
Journal Title: Journal of Clinical Oncology
Volume: 37
Issue: 22
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2019-08-01
Start Page: 1868
End Page: 1875
Language: English
ACCESSION: WOS:000482356400007
DOI: 10.1200/jco.19.00066
PROVIDER: wos
PUBMED: 30939096
Notes: Article -- Source: Wos
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MSK Authors
  1. Clifford Hudis
    875 Hudis
  2. Chau Dang
    182 Dang