title: HER2 status and efficacy of adjuvant anthracyclines in early breast cancer: a pooled analysis of randomized trials.
abstract: BACKGROUND
  Adjuvant chemotherapy with anthracyclines improves disease-free and overall survival compared with non-anthracycline-based adjuvant chemotherapy regimens in the treatment of early breast cancer. The role of HER2 status as a marker of anthracycline responsiveness has been explored by subset analyses within randomized clinical trials, with inconsistent results. We performed a pooled analysis of the interaction between HER2 status and the efficacy of adjuvant anthracyclines based on the published subset data.
  
  
  METHODS
  We searched literature databases to identify randomized trials that compared anthracycline-based with non-anthracycline-based adjuvant chemotherapy regimens in the treatment of early breast cancer and reported efficacy data according to HER2 status. Log hazard ratios (HRs) for disease-free and overall survival were pooled across the studies according to HER2 status by inverse variance weighting. A pooled test for treatment by HER2 status interaction was performed by weighted linear meta-regression. All statistical tests were two-sided.
  
  
  RESULTS
  Eight studies (with 6564 randomly assigned patients, of whom 5354 had HER2 status information available) were eligible for this analysis. In HER2-positive disease (n = 1536 patients), anthracyclines were superior to non-anthracycline-based regimens in terms of disease-free (pooled HR of relapse = 0.71; 95% confidence interval [CI] = 0.61 to 0.83; P < .001) and overall (pooled HR of death from any cause = 0.73; 95% CI = 0.62 to 0.85; P < .001) survival. In HER2-negative disease (n = 3818 patients), anthracyclines did not improve disease-free (HR = 1.00; 95% CI = 0.90 to 1.11; P = .75) or overall (HR = 1.03; 95% CI = 0.92 to 1.16; P = .60) survival. The test for treatment by HER2 status interaction yielded statistically significant results: for disease-free survival, the chi-square statistic for interaction was 13.7 (P < .001), and for overall survival, it was 12.6 (P < .001).
  
  
  CONCLUSIONS
  The added benefits of adjuvant chemotherapy with anthracyclines appear to be confined to women who have HER2 overexpressed or amplified breast tumors.
authors.affiliation: National Cancer Research Institute, Largo Rosanna Benzi, 10 16132 Genoa, Italy. alessandra.gennari@istge.it
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gennari
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Sormani
authors.forename: Paolo
authors.initials: P
authors.lastname: Pronzato
authors.forename: Matteo
authors.initials: M
authors.lastname: Puntoni
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Colozza
authors.forename: Ulrich
authors.initials: U
authors.lastname: Pfeffer
authors.forename: Paolo
authors.initials: P
authors.lastname: Bruzzi
mesh_terms: D018943:Anthracyclines / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis*; D001943:Breast Neoplasms / Q000737:chemistry* / Q000188:drug therapy* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D016014:Linear Models; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis*; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D018943:Anthracyclines; D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases