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William J. Gradishar, MD, FACP, FASCO
William J. Gradishar, MD, FACP, FASCO
Posted: Tuesday, February 15, 2022
Patients with HER2-positive primary breast cancer who achieve a pathologic complete response after neoadjuvant therapy with dual blockade of HER2 have “a good prognosis,” based on the long-term 5-year follow-up after surgery from the Neo-LaTH (JBCRG-16) trial. Tomomi Fujisawa, MD, PhD, of the Gunma Prefectural Cancer Center in Gunma, Japan, presented these data during the European Society for Medical Oncology (ESMO) Congress 2021 (Abstract 142P). They were also published in the Annals of Oncology.
“The omission of adjuvant anthracycline may be considered for patients with [pathologic complete response]; however, the risk of brain metastasis should be taken into consideration,” concluded the authors.
This randomized, phase II trial enrolled patients with HER2-positive breast cancer. Patients were randomly assigned to various lengths of neoadjuvant therapy induction with lapatinib and trastuzumab, followed by lapatinib and trastuzumab plus weekly paclitaxel therapy, with or without prolonged anti-HER2 therapy prior to chemotherapy, and with or without endocrine therapy (for those with estrogen receptor–positive disease). Patients then underwent surgical resection and received adjuvant therapy with an anthracycline-based regimen according to the physician’s choice, followed by trastuzumab and endocrine therapy (for those with estrogen receptor–positive disease).
The 5-year disease-free survival rate was 87.8%, which was higher in patients who achieved a pathologic complete response to treatment (91.7%) than those who did not (85.1%, P = .0387). Among patients who did not achieve a pathologic complete response, focally invasive tumor residues in the resected breast tissue were seen in 9 of 35 patients with estrogen receptor–negative disease and 11 of 78 patients with estrogen receptor–positive disease; there were no survival events among these 20 patients. Adjuvant anthracycline therapy was given to 48% of patients. The 5-year distant disease–free survival was similar among patients who were or were not given anthracycline treatment. Four patients had brain metastases. Two of these patients had achieved a pathologic complete response and did not receive anthracycline.
Disclosure: For a full list of authors’ disclosures, visit oncologypro.esmo.org.
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