Outcomes of HER2-positive non-metastatic breast cancer patients treated with anti-HER2 therapy without chemotherapy

Abstract

Purpose

Anti-HER2 therapy delivered in the adjuvant setting for breast cancer is given in conjunction with cytotoxic chemotherapy. For HER2-positive (HER2+) patients who cannot tolerate chemotherapy, there is no randomized data regarding the role of anti-HER2 therapy without chemotherapy.

Methods

The National Cancer Database (NCDB) was queried for non-metastatic breast cancer patients with estrogen receptor-positive (ER+) and HER2+ breast cancer who received surgery and endocrine therapy, without chemotherapy from 2013 to 2016. Outcomes were compared between endocrine therapy alone (ET) or endocrine therapy with anti-HER2 therapy (ET + aHER2). Univariate and multivariate Cox-proportional hazards models were used to analyze the association between clinical characteristics and survival outcomes between groups. Propensity score matching (PSM) was performed to account for differences between the two groups.

Results

Of all patients with non-metastatic ER+/HER2+ breast cancer, we identified 9458 (20.5%) who did not receive chemotherapy. Of the 6741 patients who received ET, 17.2% also received aHER2 therapy. Median follow-up was 31.7 months (IQR 21.1–42.1). In the aHER2 group (vs. ET), there were more patients with older age, higher stage, node positivity, poorly or undifferentiated disease, lymphovascular invasion, lobular cancer, and Medicare insurance. Compared to the ET cohort, ET + aHER2 was not significantly associated with improved OS on multivariate analysis (HR 0.88 95% CI 0.68–1.15) or after propensity score matching (HR 0.80 95% CI 0.57–1.11).

Conclusions

There is no significant difference in survival with the addition of HER2 therapy to endocrine therapy in ER+/HER2+ non-metastatic breast cancer patients who do not receive chemotherapy. To our knowledge, this is the largest series investigating this question.

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Data availability

The data used in the study are publicly available.

Code availability

Data analysis was performed using the publicly available R-statistical package.

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Funding

The authors did not receive any financial support and do not have any financial disclosures.

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Author contributions include the following: conception/design: NKG and SN; data curation: NKG, SN, SPW, CO; supervision: NKG, writing original draft: SN; interpretation of data: all authors; article writing and approval: all authors.

Corresponding author

Correspondence to Naamit K. Gerber.

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The study used retrospectively collected data from a publicly available database. No ethics approval was required.

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Nguy, S., Wu, S.P., Oh, C. et al. Outcomes of HER2-positive non-metastatic breast cancer patients treated with anti-HER2 therapy without chemotherapy. Breast Cancer Res Treat (2021). https://doi.org/10.1007/s10549-021-06115-9

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Keywords

  • Non-metastatic breast cancer
  • HER2
  • ER
  • Endocrine therapy
  • Trastuzumab
  • Chemotherapy
  • Adjuvant treatment