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The Effect of Adjuvant Trastuzumab on Locoregional Recurrence of Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Treated with Mastectomy

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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Conflict of interest

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Authors and Affiliations

  1. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Ryan M. Lanning MD, PhD, Nadeem Riaz MD, Kate Krause BS, Chun Siu BS, Xin Pei BS, Beryl McCormick MD, Simon N. Powell MD, PhD & Alice Ho MD

  2. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Monica Morrow MD, Tracy-Ann Moo MD & Mahmoud El-Tamer MD

  3. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Heather L. McArthur MD & Chau Dang MD

  4. Department of Biostatistics & Epidemiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Meier Hsu MS & Zhigang Zhang PhD

Authors
  1. Ryan M. Lanning MD, PhD
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  2. Monica Morrow MD
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  4. Heather L. McArthur MD
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  8. Kate Krause BS
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  14. Simon N. Powell MD, PhD
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  15. Alice Ho MD
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Correspondence to Alice Ho MD.

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Lanning, R.M., Morrow, M., Riaz, N. et al. The Effect of Adjuvant Trastuzumab on Locoregional Recurrence of Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer Treated with Mastectomy. Ann Surg Oncol 22, 2517–2525 (2015). https://doi.org/10.1245/s10434-014-4321-2

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  • DOI: https://doi.org/10.1245/s10434-014-4321-2

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