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The Oncologist, Vol. 12, No. 4, 390-396, April 2007; doi:10.1634/theoncologist.12-4-390
© 2007 AlphaMed Press

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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

Frédérique Penault-Llorcaa,c, Catherine Abriala, Marie-Ange Mouret-Reyniera,c, Inès Raoelfilsa, Xavier Durandoa,c, Marianne Leheurteura, Pierre Gimberguesa,c, Jacques Tortochauxa,c, Hervé Curéa,e, Philippe Cholleta,d

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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F. Penault-Llorca, C. Abrial, I. Raoelfils, P. Chollet, A. Cayre, M.-A. Mouret-Reynier, E. Thivat, F. Mishellany, P. Gimbergues, and X. Durando
Changes and Predictive and Prognostic Value of the Mitotic Index, Ki-67, Cyclin D1, and Cyclo-oxygenase-2 in 710 Operable Breast Cancer Patients Treated with Neoadjuvant Chemotherapy
Oncologist, December 1, 2008; 13(12): 1235 - 1245.
[Abstract] [Full Text] [PDF]




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