title: Pathologic complete response after neoadjuvant chemotherapy in HER2-overexpressing breast cancer according to hormonal receptor status.
abstract: OBJECTIVE
  For patients with HER2-positive breast cancer, the prognostic impact of pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) is unclear when stratified by hormonal receptor (HR) status; however, the impact of pCR on survival when stratified by hormonal receptor (HR) status is uncertain.
  
  
  METHODS
  This multicenter retrospective study investigated the predictors of pCR and its prognostic value in Japanese patients 366 HER2-positive breast cancer who received NAC. pCR was defined as no invasive residual tumor in the breast or axilla.
  
  
  RESULTS
  Median follow-up was 55 months. Multivariate analysis revealed that HR status (OR, 0.37; p < 0.001) was one of the independent predictors of pCR. Five-year recurrence-free survival was higher in HR-negative patients with pCR (93%) than in those without pCR (68%), and pCR was independently prognostic (hazard ratio, 0.32; p = 0.005). However, 5-year recurrence-free survival was not different between HR-positive patients with pCR (94%) and those without pCR (84%), and pCR was not significantly prognostic (hazard ratio, 0.53; p = 0.39). In addition, 5-year overall survivals were high and similar (97% in pCR, 94% in non-pCR). Among 204 patients treated with neoadjuvant trastuzumab, pCR was not significantly prognostic in the HR-positive group (hazard ratio, 0.63; p = 0.56).
  
  
  CONCLUSIONS
  Our study suggested that the HER2-positive HR-positive patients had a good prognosis despite the lower achievement rate of pCR, whose prognostic impact was smaller than that in the HER2-positive HR-negative patients. The treatment strategy for HER2-positive breast cancer can be stratified by HR status.
authors.affiliation: Medical Oncology, Hyogo Cancer Center, Hyogo, Japan; Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: tanioka@hp.pref.hyogo.jp.
authors.forename: Maki
authors.initials: M
authors.lastname: Tanioka
authors.affiliation: Division of Breast and Medical Oncology, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Masaoki
authors.initials: M
authors.lastname: Sasaki
authors.affiliation: Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Shimomura
authors.affiliation: Division of Breast and Endocrine Surgery, Kinki University School of Medicine, Osaka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Fujishima
authors.affiliation: Department of Medical Oncology, Hiroshima Prefectual Hospital, Hiroshima, Japan.
authors.forename: Mihoko
authors.initials: M
authors.lastname: Doi
authors.affiliation: Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Matsuura
authors.affiliation: Pathology Division, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Toshiko
authors.initials: T
authors.lastname: Sakuma
authors.affiliation: Division of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hosipital, Kyoto, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Yoshimura
authors.affiliation: Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Saeki
authors.affiliation: Breast Surgery, Hiroshima Prefectual Hospital, Hiroshima, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ohara
authors.affiliation: Medical Oncology, Kinki University School of Medicine, Osaka, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Tsurutani
authors.affiliation: Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, Nara, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Watatani
authors.affiliation: Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan.
authors.forename: Toshimi
authors.initials: T
authors.lastname: Takano
authors.affiliation: Breast and Endocrine Surgery, Toranomon Hospital, Tokyo, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Kawabata
authors.affiliation: Division of Breast and Medical Oncology, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Mukai
authors.affiliation: Division of Breast and Medical Oncology, National Cancer Center Hospital East, Chiba, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Naito
authors.affiliation: Breast Surgery, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirokaga
authors.affiliation: Breast Surgery, Hyogo Cancer Center, Hyogo, Japan.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Takao
authors.affiliation: Medical Oncology/Hematology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Minami
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D018275:Carcinoma, Lobular / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008408:Mastectomy; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012074:Remission Induction; D012189:Retrospective Studies; D000068878:Trastuzumab; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D000068878:Trastuzumab; C508053:ERBB2 protein, human
keywords: Breast cancer; HER2; Hormonal receptor; Neoadjuvant chemotherapy; Pathologic complete response; Trastuzumab