Pathologic Complete Response Rates After Neoadjuvant Pertuzumab and Trastuzumab with Chemotherapy in Early Stage HER2-Positive Breast Cancer - Increasing Rates of Breast Conserving Surgery: A Real-World Experience.

Purpose: The neoadjuvant use of pertuzumab and trastuzumab with chemotherapy improves the pathologic complete response (pCR) in early HER2+ breast cancer. The aim of this study was to determine the pCR rate obtained with dual HER2 blockade in routine clinical practice. The secondary and tertiary objective was to investigate the impact of neoadjuvant systemic therapy (NST) on performing breast-conserving surgery and survival data. Methods: This was a multicentre, retrospective, observational study in patients with stage II and III HER2+ early breast cancer who received pertuzumab and trastuzumab-based NST. Data were collected from patients' medical records. Results: Eighty-two patients were included in the study treated in 8 cancer centers in Hungary between March 2015 and January 2020. The study included women with a median age of 50.3 years. The majority of the patients (95%) received a sequence of anthracycline-based chemotherapy followed by docetaxel. pCR was achieved in 54% of the cases. As a result of NST a significant increase of conservative breast surgeries (33% vs. 3.6% planned, p = 0.0001) was observed. Ki67 expression and neutrophil-to-lymphocyte ratio (NLR) significantly predicted pCR. None of the variables were independent predictors of DFS. Conclusion: The pCR rate achieved in our study demonstrates the reproducibility of trial data in a real-world population. The rate of breast-conserving surgery was significantly increased.
Competing Interests: The authors declare that there are no known conflicts of interest associated with this publication and there was no significant financial support for this work that could have influenced its outcome. The authors state that the following financial relationships were not in any respect related to the present study. KB received consulting fees from Pfizer, Novartis, Eli Lilly, and Roche. ZH has received speaker honorarium from Roche, Pfizer, Eli-Lilly, Novartis, AstraZeneca, Amgen, Swixx, Bayer, Sandoz, Merck, Abbvie, Amicus, Egis, TEVA, Boeringer, BMS, Med-Gen Sol, and Oncompass. ZK received consulting fees from AstraZeneca EGIS, Pfizer, Novartis, Eli Lilly, Richter, and Roche. LL received consulting fees from Roche. GR received consulting fees from Pfizer, Novartis, Eli Lilly, and Roche. AR, TC, KM and BB declares no conflict of interest.
(Copyright © 2021 Boér, Kahán, Landherr, Csőszi, Máhr, Ruzsa, Horváth, Budai and Rubovszky.)