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Breast Cancer

Achieving Higher Pathological Complete Response Rates in HER-2–Positive Patients With Induction Chemotherapy Without Trastuzumab in Operable Breast Cancer

^aCentre Jean Perrin, Clermont-Ferrand, France; ^bINSERM U484, Clermont-Ferrand, France; ^cUniversité d'Auvergne, Faculté de Médecine, Clermont-Ferrand, France; ^dCentre d'Investigation Clinique, Clermont-Ferrand, France; ^eCentre Hospitalier Universitaire, Clermont-Ferrand, France

Key Words. Breast cancer • Pathological response • HER-2

Correspondence: Catherine Abrial, Ph.D., Centre Jean Perrin, Bureau de Recherche Clinique, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand Cedex 1, France. Telephone: 33-4-73-27-80-05; Fax: 33-4-73-27-80-29; e-mail: catherine.abrial{at}tiscali.fr

Recent trials of induction chemotherapy in bulky operable breast cancer have shown much higher pathological complete response (pCR) rates with trastuzumab-driven combinations. However, it is useful to take into account the specific chemosensitivity of HER-2–positive tumors. The aim of this study was to assess the pCR rate according to HER-2 status in response to chemotherapy, without an anti–HER-2 specific biological agent, in 710 operable breast cancer patients. Since 1982, these patients have been treated with several different neoadjuvant chemotherapy combinations. During this period, HER-2 overexpression was most often not assessed. Subsequently, we assessed HER-2 expression using archival paraffin-embedded tissue. A technically usable specimen was available for 413 of the 710 patients. Before treatment, 51 patients were HER-2 positive, 287 patients were HER-2 negative, and the results were inconclusive for 75 patients. Of these patients, a pCR in breast and nodes was obtained in 94 patients (14.3%), but this event was threefold more frequent for HER-2–positive patients (23.5%) than for HER-2–negative patients (7%).

The overall survival (OS) and disease-free survival (DFS) rates at 10 years were 66.6% and 57.4%, respectively. The DFS rate was, as expected, better for HER-2–negative patients, with HER-2 status assessed before as well as after chemotherapy. A significant difference was found for OS in favor of HER-2–negative patients only with postchemotherapy assessment of HER-2, a fact similar to our previous findings. Finally, there was a tendency toward a higher DFS rate for HER-2–positive patients who achieved a pCR compared with HER-2–positive patients who did not.

Disclosure of potential conflicts of interest is found at the end of this article.

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