title: Effectiveness of neoadjuvant trastuzumab and chemotherapy in HER2-overexpressing breast cancer.
abstract: OBJECTIVE
  Trastuzumab and chemotherapy is the current standard of care in HER2+ early or locally advanced breast cancer, but there are scanty literature data of its real world effectiveness.
  
  
  METHODS
  We retrospectively reviewed 205 patients with HER2+ breast cancer diagnosed in 10 Italian Medical Oncology Units between July 2003 and October 2011. All patients received neoadjuvant systemic therapy (NST) with trastuzumab in association with chemotherapy. Many different chemotherapy regimens were used, even if 90 % of patients received schemes including anthracyclines and 99 % received taxanes. NST was administered for more than 21 weeks (median: 24) in 130/205 (63.4 %) patients, while trastuzumab was given for more than 12 weeks (median: 12 weeks) in 101/205 (49.3 %) patients. pCR/0 was defined as ypT0+ypN0, and pCR/is as ypT0/is+ypN0.
  
  
  RESULTS
  pCR/0 was obtained in 24.8 % and pCR/is in 46.8 % of the patients. At multivariate logistic regression, nonluminal/HER2+ tumors (P < 0.0001) and more than 12 weeks of neoadjuvant trastuzumab treatment (P = 0.03) were independent predictors of pCR/0. Median disease-free survival (DFS) and cancer-specific survival (CSS) have not been reached at the time of analysis. At multivariate analysis, nonluminal/HER2+ subclass (DFS: P = 0.01 and CSS: P = 0.01) and pathological stage II-III at surgery (DFS: P < 0.0001 and CSS: P = 0.001) were the only variables significantly associated with a worse long-term outcome.
  
  
  CONCLUSIONS
  Our data set the relevance of molecular subclasses and residual tumor burden after neoadjuvant as the most relevant prognostic factors for survival in this cohort of patients.
authors.affiliation: Medical Oncology Unit, Department of Experimental and Clinical Sciences, University G d'Annunzio, 66013 Chieti, Italy. natoli@unich.it
authors.forename: Clara
authors.initials: C
authors.lastname: Natoli
authors.forename: Patrizia
authors.initials: P
authors.lastname: Vici
authors.forename: Isabella
authors.initials: I
authors.lastname: Sperduti
authors.forename: Antonino
authors.initials: A
authors.lastname: Grassadonia
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Bisagni
authors.forename: Nicola
authors.initials: N
authors.lastname: Tinari
authors.forename: Andrea
authors.initials: A
authors.lastname: Michelotti
authors.forename: Germano
authors.initials: G
authors.lastname: Zampa
authors.forename: Stefania
authors.initials: S
authors.lastname: Gori
authors.forename: Luca
authors.initials: L
authors.lastname: Moscetti
authors.forename: Michele
authors.initials: M
authors.lastname: De Tursi
authors.forename: Michele
authors.initials: M
authors.lastname: Panebianco
authors.forename: Maria
authors.initials: M
authors.lastname: Mauri
authors.forename: Ilaria
authors.initials: I
authors.lastname: Ferrarini
authors.forename: Laura
authors.initials: L
authors.lastname: Pizzuti
authors.forename: Corrado
authors.initials: C
authors.lastname: Ficorella
authors.forename: Riccardo
authors.initials: R
authors.lastname: Samaritani
authors.forename: Lucia
authors.initials: L
authors.lastname: Mentuccia
authors.forename: Stefano
authors.initials: S
authors.lastname: Iacobelli
authors.forename: Teresa
authors.initials: T
authors.lastname: Gamucci
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D015870:Gene Expression; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy* / Q000378:metabolism / Q000401:mortality; D016016:Proportional Hazards Models; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics / Q000378:metabolism*; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage; D000068878:Trastuzumab; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines; D061067:Antibodies, Monoclonal, Humanized; D018719:Erb-b2 Receptor Tyrosine Kinases; D043823:Taxoids; D000068878:Trastuzumab; C508053:ERBB2 protein, human