title: Pathologic complete response to neoadjuvant chemotherapy with trastuzumab predicts for improved survival in women with HER2-overexpressing breast cancer.
abstract: BACKGROUND
  We sought to determine the prognostic value of pathologic response to neoadjuvant chemotherapy with concurrent trastuzumab.
  
  
  METHODS
  Two hundred and twenty-nine women with HER2/neu (HER2)-overexpressing breast cancer were treated with neoadjuvant chemotherapy plus trastuzumab between 2001 and 2008. Patients were grouped based on pathologic complete response (pCR, n = 114) or less than pCR (<pCR, n = 115); as well as by pathologic stage. Locoregional recurrence-free (LRFS), distant metastasis-free (DMFS), recurrence-free (RFS), and overall survival (OS) rates were compared.
  
  
  RESULTS
  The median follow-up was 63 (range 53-77) months. There was no difference in clinical stage between patients with pCR or <pCR. Compared with patients achieving <pCR, those with the pCR had higher 5-year rates of LRFS (100% versus 95%, P = 0.011), DMFS (96% versus 80%, P < 0.001), RFS (96% versus 79%, P < 0.001), and OS (95% versus 84%, P = 0.006). Improvements in RFS and OS were seen with decreasing post-treatment stage. Failure to achieve a pCR was the strongest independent predictor of recurrence (hazard ratio [HR] = 4.09, 95% confidence interval [CI]: 1.67-10.04, P = 0.002) and death (HR = 4.15, 95% CI: 1.39-12.38, P = 0.011).
  
  
  CONCLUSIONS
  pCR and lower pathologic stage after neoadjuvant chemotherapy with trastuzumab are the strongest predictors of recurrence and survival and are surrogates of the long-term outcome in patients with HER2-overexpressing disease.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Kim
authors.forename: P
authors.initials: P
authors.lastname: Allen
authors.forename: A M
authors.initials: AM
authors.lastname: Gonzalez-Angulo
authors.forename: W A
authors.initials: WA
authors.lastname: Woodward
authors.forename: F
authors.initials: F
authors.lastname: Meric-Bernstam
authors.forename: A U
authors.initials: AU
authors.lastname: Buzdar
authors.forename: K K
authors.initials: KK
authors.lastname: Hunt
authors.forename: H M
authors.initials: HM
authors.lastname: Kuerer
authors.forename: J K
authors.initials: JK
authors.lastname: Litton
authors.forename: G N
authors.initials: GN
authors.lastname: Hortobagyi
authors.forename: T A
authors.initials: TA
authors.lastname: Buchholz
authors.forename: E A
authors.initials: EA
authors.lastname: Mittendorf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality; D018572:Disease-Free Survival; D000077143:Docetaxel; D005260:Female; D006801:Humans; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009362:Neoplasm Metastasis / Q000188:drug therapy / Q000517:prevention & control; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000517:prevention & control; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000627:therapeutic use; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D013534:Survival; D043823:Taxoids / Q000627:therapeutic use; D000068878:Trastuzumab; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000972:Antineoplastic Agents, Phytogenic; D000077143:Docetaxel; D017239:Paclitaxel; D018719:Erb-b2 Receptor Tyrosine Kinases; D043823:Taxoids; D000068878:Trastuzumab; C508053:ERBB2 protein, human
keywords: HER2; breast cancer; neoadjuvant chemotherapy; pathologic complete response; trastuzumab
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