Breast cancer-specific survival in patients with HER2-positive, node-negative T1a and T1b breast cancer

PURPOSE: Hormone receptor expression (presence-positive or absence-negative) may reflect different stages of one disease or different breast cancer types. Determining whether hormone receptor expression represents one or more breast cancer phenotypes would have important paradigmatic and practical implications. METHODS: Breast cancer records were obtained from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database. The study included 19,541 non-Hispanic white women with node-negative breast cancer. Standard tumor cell characteristics and breast cancer-specific survival were analyzed by independent estrogen receptor (ER+ and ER−), independent progesterone receptor (PR+ and PR−), and joint ERPR expression (ER+PR+, ER+PR−, ER−PR+, and ER−PR−). RESULTS: Age frequency density plots by hormone receptor expression showed two overlapping breast cancer populations with early-onset and/or late-onset etiologies. Independent ER+ and PR+ phenotype were associated with smaller tumor sizes, better grade, and better cancer-specific survival than ER− and PR− breast cancer types. Joint ERPR phenotype exhibited biologic gradients for tumor size, grade, and cancer-specific survival, which ranked from good to worse for ER+PR+ to ER+PR− to ER−PR+ to ER−PR−. CONCLUSION: Variations of standard tumor cell characteristics and breast cancer–specific survival by hormone receptor expression in white patients with node-negative breast cancer suggested two breast cancer phenotypes with overlapping etiologies and distinct clinical features.

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Breast cancer specific survival (BCSS) in young women <40 years with node negative luminal breast cancer (BC) treated based on tumor gene expression

Annals of Oncology ◽

10.1093/annonc/mdx385.008 ◽

2017 ◽

Vol 28 ◽

pp. v514

Author(s):

S. Shak ◽

M. Roberts ◽

D. Miller ◽

A. Kurian ◽

V. Petkov

Keyword(s):

Breast Cancer ◽

Gene Expression ◽

Young Women ◽

Luminal Breast Cancer ◽

Breast Cancer Specific Survival ◽

Cancer Specific Survival ◽

Node Negative ◽

Tumor Gene Expression ◽

Tumor Gene

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De-escalation of radiation therapy in patients with stage I, node-negative, HER2-positive breast cancer

npj Breast Cancer ◽

10.1038/s41523-021-00242-8 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Jose G. Bazan ◽

Sachin R. Jhawar ◽

Daniel Stover ◽

Ko Un Park ◽

Sasha Beyer ◽

...

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Local Therapy ◽

Adjuvant Radiation ◽

Her2 Positive ◽

Node Negative ◽

Risk Of Death ◽

Her2 Breast Cancer ◽

Neoadjuvant Systemic Therapy ◽

Increased Risk

AbstractIn the modern era, highly effective anti-HER2 therapy is associated with low local-regional recurrence (LRR) rates for early-stage HER2+ breast cancer raising the question of whether local therapy de-escalation by radiation omission is possible in patients with small-node negative tumors treated with lumpectomy. To evaluate existing data on radiation omission, we used the National Cancer Database (NCDB) to test the hypothesis that RT omission results in equivalent overall survival (OS) in stage 1 (T1N0) HER2+ breast cancer. We excluded patients that received neoadjuvant systemic therapy. We stratified the cohort by receipt of adjuvant radiation. We identified 6897 patients (6388 RT; 509 no RT). Patients that did not receive radiation tended to be ≥70 years-old (odds ratio [OR] = 3.69, 95% CI: 3.02–4.51, p < 0.0001), to have ≥1 comorbidity (OR = 1.33, 95% CI: 1.06–1.68, p = 0.0154), to be Hispanic (OR = 1.49, 95% CI: 1.00–2.22, p = 0.049), and to live in lower income areas (OR = 1.32, 95% CI: 1.07–1.64, p = 0.0266). Radiation omission was associated with a 3.67-fold (95% CI: 2.23–6.02, p < 0.0001) increased risk of death. While other selection biases that influence radiation omission likely persist, these data should give caution to radiation omission in T1N0 HER2+ breast cancer.

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Adjuvant Paclitaxel and Trastuzumab for Node-Negative, HER2-Positive Breast Cancer

New England Journal of Medicine ◽

10.1056/nejmoa1406281 ◽

2015 ◽

Vol 372 (2) ◽

pp. 134-141 ◽

Cited By ~ 334

Author(s):

Sara M. Tolaney ◽

William T. Barry ◽

Chau T. Dang ◽

Denise A. Yardley ◽

Beverly Moy ◽

...

Keyword(s):

Breast Cancer ◽

Her2 Positive ◽

Node Negative ◽

Her2 Positive Breast Cancer ◽

Positive Breast Cancer

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Classical Cyclophosphamide, Methotrexate, and Fluorouracil Chemotherapy Is More Effective in Triple-Negative, Node-Negative Breast Cancer: Results From Two Randomized Trials of Adjuvant Chemoendocrine Therapy for Node-Negative Breast Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.25.9549 ◽

2010 ◽

Vol 28 (18) ◽

pp. 2966-2973 ◽

Cited By ~ 102

Author(s):

Marco Colleoni ◽

Bernard F. Cole ◽

Giuseppe Viale ◽

Meredith M. Regan ◽

Karen N. Price ◽

...

Keyword(s):

Breast Cancer ◽

Endocrine Therapy ◽

Triple Negative ◽

Alkylating Agents ◽

Growth Factor Receptor ◽

Breast Cancers ◽

Her2 Positive ◽

Node Negative ◽

Tumor Subtypes ◽

Node Negative Breast Cancer

Purpose Retrospective studies suggest that primary breast cancers lacking estrogen receptor (ER) and progesterone receptor (PR) and not overexpressing human epidermal growth factor receptor 2 (HER2; triple-negative tumors) are particularly sensitive to DNA-damaging chemotherapy with alkylating agents. Patients and Methods Patients enrolled in International Breast Cancer Study Group Trials VIII and IX with node-negative, operable breast cancer and centrally assessed ER, PR, and HER2 were included (n = 2,257). The trials compared three or six courses of adjuvant classical cyclophosphamide, methotrexate, and fluorouracil (CMF) with or without endocrine therapy versus endocrine therapy alone. We explored patterns of recurrence by treatment according to three immunohistochemically defined tumor subtypes: triple negative, HER2 positive and endocrine receptor absent, and endocrine receptor present. Results Patients with triple-negative tumors (303 patients; 13%) were significantly more likely to have tumors > 2 cm and grade 3 compared with those in the HER2-positive, endocrine receptor–absent, and endocrine receptor–present subtypes. No clear chemotherapy benefit was observed in endocrine receptor–present disease (hazard ratio [HR], 0.90; 95% CI, 0.74 to 1.11). A statistically significantly greater benefit for chemotherapy versus no chemotherapy was observed in triple-negative breast cancer (HR, 0.46; 95% CI, 0.29 to 0.73; interaction P = .009 v endocrine receptor–present disease). The magnitude of the chemotherapy effect was lower in HER2-positive endocrine receptor–absent disease (HR, 0.58; 95% CI, 0.29 to 1.17; interaction P = .24 v endocrine receptor–present disease). Conclusion The magnitude of benefit of CMF chemotherapy is largest in patients with triple-negative, node-negative breast cancer.

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