Adjuvant ovarian function suppression and aromatase inhibitors in premenopausal patients with hormone receptor and HER2 positive breast cancer, by timing of chemotherapy and trastuzumab and response to neoadjuvant therapy.
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Shai Ayelet, Wildiers Hans, Venieri Claudio, Pogoda Katarzyna, Linderholm Barbro, Lambertini Matteo, Matos Leonor, De Maio D'Esposito Eleonora, Hajjaji Nawale, Matos Erika, González Cortijo Lucía, Fotia Giuseppe, Fortuna Ana, Sella Tal, Gouveia Helena, Rosset Laurent, Constantinidou Anastasia, Angeli Eurydice, Cicin Irfan, Tjan-Heijnen Vivianne, Ruyssers Natacha, Demasure Sofie, Abu Remilah Areen, Huygh Greet, Paluch-Shimon Shani, Chiappe Edoardo, Shirron Natali, Neven Patrick, Artac Mehmet, Kilictas Bilgesah, Baranseh Jalal, Vicente-Rubio Elena, Atci Mustafa, Amato Ottavia, van Duijnhoven Frederieke
Аннотация
METHODS: Patients aged <45Y at diagnosis, with stage I-III HR + HER2+ BC, treated with (neo)adjuvant chemotherapy and trastuzumab ( ± pertuzumab) and endocrine therapy were included. LHRH-agonists and oophorectomy were considered OFS. We compared distant disease-free survival (DDFS) with tamoxifen, OFS + tamoxifen and OFS + AI in three cohorts: neoadjuvant-pathologic complete response (pCR), neoadjuvant-residual disease (RD) and adjuvant. Endocrine therapy (ET) was modeled as a time dependent covariate in cox logistic regression analyses.
RESULTS: The study included 1124 patients with median follow-up of 72.6 months (range:0-205 months). DDFS rates at 5 years were 83.9 %, 86.8 % and 92.1 % with tamoxifen, OFS + tamoxifen and OFS + AI respectively in the RD group, 94.3 %, 97.6 % and 96.5 % in the pCR group, and 94.3 %, 93.4 % and 98.6 % in the adjuvant group. OFS + AI was associated with better DDFS compared to tamoxifen in the RD group (n = 366) (multivariable weighted HR 0.28. 95 % CI 0.11-.069, p = 0.006), but associations of ET with DDFS in the pCR (n = 307, p = 0.59) and adjuvant (n = 451, p = 0.18) cohorts were not detected. Stage III was associated with worse DDFS in all groups.
CONCLUSION: OFS + AI were associated with better DDFS in patients with RD after neoadjuvant therapy. Our findings can assist shared decision-making on adjuvant endocrine therapy of these patients.