The effect of adjuvant trastuzumab on locoregional recurrence of human epidermal growth factor receptor 2-positive breast cancer treated with mastectomy Journal Article


Authors: Lanning, R. M.; Morrow, M.; Riaz, N.; Mcarthur, H. L.; Dang, C.; Moo, T. A.; El-Tamer, M.; Krause, K.; Siu, C.; Hsu, M.; Zhang, Z.; Pei, X.; McCormick, B.; Powell, S. N.; Ho, A.
Article Title: The effect of adjuvant trastuzumab on locoregional recurrence of human epidermal growth factor receptor 2-positive breast cancer treated with mastectomy
Abstract: Background: Human epidermal growth factor receptor 2 (HER2) overexpression was associated with locoregional recurrence (LRR) in the preadjuvant trastuzumab era. This study aimed to examine the effect of trastuzumab on LRR in mastectomy patients and whether it varied with postmastectomy radiation (PMRT). Methods: From the authors’ institutional database, 501 women with stages I–III HER2-positive breast cancer who underwent mastectomy from 1998 to 2007 were identified. A landmark analysis was performed to compare two cohorts: 170 women who received trastuzumab and 281 who did not. Kaplan–Meier methods were used to estimate locoregional recurrence-free survival (LRRFS). A propensity score analysis was used to balance the treatment groups with respect to multiple covariates. Analogous methods were used to study the effect of PMRT. Results: The women in the trastuzumab group were more likely to be node positive and to receive systemic therapy or PMRT (p < 0.01). The 5-year LRRFS was 98 % in the trastuzumab troup versus 94 % in the no trastuzumab group [hazard ratio (HR) 0.31; 95 % confidence interval (CI) 0.09–1.09; p = 0.07]. After adjustment for multiple covariates, including receipt of chemotherapy and PMRT, trastuzumab decreased LRR rates (HR 0.21; 95 % CI 0.04–0.94; p = 0.04). Among the women who received PMRT, trastuzumab reduced the 5-year LRR rate (0 vs 5 %; p = 0.06). Among those who did not receive PMRT, trastuzumab did not significantly decrease LRR (3 vs 6 %; p = 0.26). Conclusion: High rates of locoregional control (5-year rate, 98 %) were observed among patients who received trastuzumab and mastectomy ± PMRT. Trastuzumab decreased LRR in HER2-positive women who received mastectomy and PMRT, suggesting that the largest benefit is seen in a higher-risk subset of patients. © 2014, Society of Surgical Oncology.
Keywords: adult; controlled study; aged; major clinical study; overall survival; systemic therapy; cancer adjuvant therapy; cancer patient; breast cancer; mastectomy; epidermal growth factor receptor 2; drug effect; distant metastasis; high risk patient; kaplan meier method; trastuzumab; propensity score; local recurrence free survival; human; female; article
Journal Title: Annals of Surgical Oncology
Volume: 22
Issue: 8
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2015-08-01
Start Page: 2517
End Page: 2525
Language: English
DOI: 10.1245/s10434-014-4321-2
PROVIDER: scopus
PUBMED: 25564167
DOI/URL:
Notes: Export Date: 2 September 2015 -- Source: Scopus
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MSK Authors
  1. Alice Yoosun Ho
    122 Ho
  2. Zhigang Zhang
    428 Zhang
  3. Meier Hsu
    169 Hsu
  4. Monica Morrow
    772 Morrow
  5. Simon Nicholas Powell
    331 Powell
  6. Chau Dang
    272 Dang
  7. Nadeem Riaz
    418 Riaz
  8. Mahmoud B. El-Tamer
    105 El-Tamer
  9. Beryl McCormick
    372 McCormick
  10. Xin Pei
    134 Pei
  11. Ryan Michael Lanning
    14 Lanning
  12. Kate Krause
    15 Krause
  13. Tracy-Ann Moo
    96 Moo
  14. Chun Ting Siu
    16 Siu