Contemporary Locoregional Recurrence Rates in Young Patients With Early-Stage Breast Cancer

Purpose The aim of this study was to evaluate contemporary rates of local recurrence (LR) and regional recurrence (RR) in young patients with breast cancer in relation to tumor biology as expressed by biomarker subtypes. Patients and Methods Women < 35 years of age who underwent surgery for primary unilateral invasive breast cancer between 2003 and 2008 were selected from the Netherlands Cancer Registry. Patients were categorized according to biomarker subtypes on the basis of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. The 5-year risks of developing LR and regional lymph node recurrence were estimated by using Kaplan-Meier statistics. Results A total of 1,000 patients were identified, of whom 59% had a known subtype: 39% HR-positive/HER2-negative; 17% HR-positive/HER2-positive; 10% HR-negative/HER2-positive; and 34% HR-negative/HER2-negative (triple negative). Overall 5-year LR and RR rates were 3.5% and 3.7%, respectively. A decreasing trend for both rates was observed over time and was accompanied by a significant decrease in the risk of distant metastases (DM). LR occurred in 4.2%, RR in 6.1%, and DM in 17.8% of patients in 2003, and in 3.2%, 4.4%, and 10.0%, respectively, in 2008. LR and RR rates varied with biomarker subtype. These differences were borderline significant when analyzed for the entire study period (P = .056 and P = .014, respectively) and leveled off after the introduction of trastuzumab after 2005 (P = .24 and P = .42, respectively). Patients with lymph node metastases at the time of diagnosis had an increased risk of RR. The type of surgery performed—breast-conserving or mastectomy—did not influence rates of LR and RR. Conclusion Overall, the rates of LR and RR in young patients with early-stage breast cancer were relatively low and varied by biomarker subtype.

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Adjuvant trastuzumab regimen for HER2-positive early-stage breast cancer: a systematic review and meta-analysis

Expert Review of Clinical Pharmacology ◽

10.1080/17512433.2019.1637252 ◽

2019 ◽

Vol 12 (8) ◽

pp. 815-824 ◽

Cited By ~ 4

Author(s):

Anne Julienne Genuino ◽

Usa Chaikledkaew ◽

Due Ong The ◽

Thanyanan Reungwetwattana ◽

Ammarin Thakkinstian

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Early Stage ◽

Meta Analysis ◽

Early Stage Breast Cancer ◽

Her2 Positive ◽

Adjuvant Trastuzumab

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Continued efficacy of neratinib in patients with HER2-positive (HER2+) early-stage breast cancer: final overall survival (OS) analysis from the randomized phase 3 ExteNET trial

The Breast ◽

10.1016/s0960-9776(21)00093-x ◽

2021 ◽

Vol 56 ◽

pp. S19

Author(s):

M. Martin ◽

F.A. Holmes ◽

B. Moy ◽

J. Mansi ◽

M. Gnant ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Early Stage ◽

Early Stage Breast Cancer ◽

Her2 Positive ◽

Phase 3

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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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RE: Predictors of increased risk for early treatment non-adherence to oral anti-estrogen therapies in early stage breast cancer patients

Breast Cancer Research and Treatment ◽

10.1007/s10549-021-06146-2 ◽

2021 ◽

Vol 186 (2) ◽

pp. 585-586

Author(s):

Xiao‑Min Li ◽

Hong-Lin Chen

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Early Treatment ◽

Early Stage ◽

Early Stage Breast Cancer ◽

Breast Cancer Patients ◽

Increased Risk

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Bringing diarrhea under CONTROL: dose escalation reduces neratinib-associated diarrhea and improves tolerability in HER2-positive early-stage breast cancer

The Breast ◽

10.1016/s0960-9776(21)00092-8 ◽

2021 ◽

Vol 56 ◽

pp. S18-S19

Author(s):

M. Ruiz-Borrego ◽

A. Chan ◽

G. Marx ◽

A. Brufsky ◽

M. Trudeau ◽

...

Keyword(s):

Breast Cancer ◽

Dose Escalation ◽

Early Stage ◽

Early Stage Breast Cancer ◽

Her2 Positive

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Loco-regional recurrence trend and prognosis in young women with breast cancer according to molecular subtypes: analysis of 1099 cases

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02214-5 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Yang Li ◽

Su Lu ◽

Yuhan Zhang ◽

Shuaibing Wang ◽

Hong Liu

Keyword(s):

Breast Cancer ◽

Local Recurrence ◽

Molecular Subtypes ◽

Early Stage ◽

Young Patients ◽

Distant Metastases ◽

Early Stage Breast Cancer ◽

Regional Recurrence ◽

Her2 Status ◽

Over Time

Abstract Background The number of young patients diagnosed with breast cancer is on the rise. We studied the rate trend of local recurrence (LR) and regional recurrence (RR) in young breast cancer (YBC) patients and outcomes among these patients based on molecular subtypes. Methods A retrospective cohort study was conducted based on data from Tianjin Medical University Cancer Institute and Hospital for patients ≤ 35 years of age with pathologically confirmed primary invasive breast cancer surgically treated between 2006 and 2014. Patients were categorized according to molecular subtypes on the basis of hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status. The 5-year rates for LR, RR, and distant metastases (DM) were estimated by Kaplan-Meir statistics. Nelson-Aalen cumulative-hazard plots were used to describe local recurrence- and distant metastasis-free intervals. Results We identified 25,284 patients with a median follow-up of 82 months, of whom 1099 (4.3%) were YBC patients ≤ 35 years of age. The overall 5-year LR, RR, and DM rates in YBC patients were 6.7%, 5.1%, and 16.6%, respectively. The LR and RR rates demonstrated a decreasing trend over time (P = 0.028 and P = 0.015, respectively). We found that early-stage breast cancer and less lymph node metastases increased over time (P = 0.004 and P = 0.007, respectively). Patients with HR−/HER2+ status had a significantly higher LR (HR 20.4; 95% CI, 11.8–35.4) and DM (HR 37.2; 95% CI, 24.6–56.3) at 10 years. Breast-conserving surgery (BCS) or mastectomy did not influence rates of LR and RR. In the overall population, the 5-year survival of YBC patients exceeded 90%. Conclusions The rates of LR and RR with YBC patients demonstrated a downward trend and the proportion of early-stage breast cancer increased between 2006 and 2014. We report the highest LR rates in this young population were associated with HR−/HER2+ tumors.

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