GBCC Oral Presentation PROGNOSIS AND EFFECT OF ADJUVANT TREATMENT IN - PowerPoint PPT Presentation

GBCC Oral Presentation PROGNOSIS AND EFFECT OF ADJUVANT TREATMENT IN IN SMALL, NODE(-), HER2(+) BREAST CANCER Wonju Severance Christianity Hospital Seungtaek Lim

Background • The prognosis of HER2+ early breast cancer has been improved by adjuvant trastuzumab, but evidence is lacking for small(<1cm), node (-) disease Future Oncol. (2015) 11(24), 3261-3271

Background • Although outcomes of T1abN0 HER2+ tumors vary among observational studies, there is 10-20% risk of recurrence at 5 or more years. • Netherland Cancer registry • Retrospective data of 3512 patients with T1N0M0 HER2 (+) disease • 385 (11%) T1a, 800 (23%) T1b, 2327 (66%) T1c

Netherland Cancer Registry (2006~2012) All pT1a pT1 pT1c b • Limitation • Only Overall Survival Data • >90% patients received adjuvant Trastuzumab with Chemotherapy BCRT 2016

Purpose • We intend to investigate • The overall prognosis of Small (<1cm), Node (-), HER2 (+) breast cancer patients after curative surgery • Treatment patterns for the patients and difference according to pT stage (T1a vs. 1b), Receptor (HR+ vs. HR-) • The effect of adjuvant treatment (chemotherapy, and/or trastuzumab) in the population

Methods • Inclusion criteria • Curative surgery for breast cancer • Diagnosed at Jan 2005~July 2016 • Yonsei Cancer center, Gangnam Severance, Wonju Severance • pT1a or T1b (<1cm), node (-) • HER2 (+) • Exclusion criteria: neo-adjuvant chemotherapy, Tis, bilateral case • We collected data regarding • Baseline demographics • Histology and Receptor status (ER, PR) • Surgical methods (mastectomy vs. BCS) • Adjuvant treatment (chemotherapy, endocrine therapy, and trastuzumab)

Baseline Characteristics of all patients pT1b (N=254) pT1a (N=267) Characteristics Total (N=254) Characteristics Total (N=267) Age (years, median, range) 51 (22~80) Age (years, median, range) 51 (30~74) ER status ER status NO 70 (27.6%) NO 122 (45.7%) Yes Yes 184 (72.4%) 145 (54.3%) PR status PR status No No 126 (49.6%) 166 (62.2%) Yes 128 (50.4%) Yes 100 (37.5%) HR status HR status No 62 (24.4%) No 77 (28.8%) Yes 192 (75.6%) Yes 190 (71.2%) OP OP BCS BCS 151 (59.4%) 118 (44.32%) MRM 103 (40.6%) MRM 149 (55.8%) Histology type Histology type Ductal carcinoma 240 (94.5%) Ductal carcinoma 248 (92.9%) Lobular carcinoma 8 (3.1%) Lobular carcinoma 15 (5.6%) Others Others 6 (1.4%) 4 (1.5%) Histology grade Histology grade 1 64 (29.0%) 1 58 (21.7%) 2 116 (52.5%) 2 119 (44.6%) 3 33 (14.9%) 3 23 (8.6%) Unknown 8 (3.6 %) Unknown 67 (25.1%) Nuclear grade Nuclear grade 1 1 24 (11%) 27 (10.1%) 2 2 114 (52.1%) 87 (32.6%) 3 3 48 (21.9%) 38 (14.2%) Unknown 33 (15.1%) Unknown 115 (43.1%) Trastuzumab Trastuzumab No 229 (90.2%) No 55 (95.5%) Yes Yes 25 (9.8%) 12 (4.5%) Adjuvant Chemotherapy Adjuvant Chemotherapy No No 234 (87.6%) 139 (54.7%) Yes 33 (12.4%) Yes 115 (45.3%)

Baseline Characteristics of pT1a, Node (-), HER2 (+) patients (N=267) Characteristics No CTx (N=234) CTx (N=33) P Age (years, median, range) 51.2 47.6 0.021 Sex Female 234(100%) 33 (100%) NA ER status NO 103 (84.4%) 19 (15.6%) 0.143 Yes 131 (90.3%) 14 (9.7%) PR status No 0.191 142 (85.5%) 24 (14.5%) Yes 91 (91.0%) 9 (9.0%) HR status No 65 (84.4%) 12 (15.6%) 0.308 Yes 169 (88.9%) 21 (11.1%) OP BCS 101 (85.6%) 17 (14.4%) 0.366 MRM 133 (89.3%) 16 (10.7%) Histology type Ductal carcinoma 217 (87.5%) 31(12.5%) 0.748 Lobular carcinoma 13 (86.7%) 2 (13.3%) Others 4 (100.0%) 0 (0%) Histology grade 1 49 (84.5%) 9 (15.5%) 2 103 (86.6%) 16 (13.4%) 0.541 3 20 (87.0%) 3 (13.0%) Unknown 62 (92.5%) 5 (7.5%) Nuclear grade 1 26 (96.3%) 1 (3.7%) 2 73 (83.9%) 14 (16.1%) 0.372 3 33 (86.8%) 5 (13.2%) Unknown 102 (88.7%) 13 (11.3%) Trastuzumab No 234 (91.8%) 21 (8.2%) <0.001 Yes 0 (0.0%) 12 (100.0%)

Baseline Characteristics of pT1b, Node (-), HER2 (+) patients (N=254) Characteristics No CTx (N=139) CTx (N=115) P Age (years, median, range) 52.8 48.7 0.001 Sex Female 115(100%) 85 (100%) NA ER status NO 20 (28.6%) 50 (71.4%) <0.001 Yes 119 (64.7%) 65 (35.3%) PR status No 0.03 61 (48.4%) 65 (51.6%) Yes 78 (60.9%) 50 (39.1%) HR status No 18 (29.0%) 44 (71.0%) <0.001 Yes 121 (63.0%) 71 (37.0%) OP BCS 93 (61.6%) 58 (38.4%) 0.006 MRM 46 (44.7%) 57 (55.3%) Histology type Ductal carcinoma 127 (52.9%) 113 (47.1%) 0.026 Lobular carcinoma 8 (100.0%) 0 (0%) Others 4 (66.7%) 2 (33.3%) Histology grade 1 51 (70.8%) 21 (29.2%) 2 67 (51.5%) 63 (48.5%) <0.001 3 9 (23.1%) 30 (76.9%) Unknown 8 (100%) 0 (0%) Nuclear grade 1 20 (83.3%) 4 (16.7%) 2 70 (61.4%) 44 (38.6%) <0.001 3 15 (31.3%) 33 (68.8%) Unknown 16 (48.5%) 17 (51.5%) Trastuzumab No 139 (60.7%) 90 (39.3%) <0.001 Yes 0 (0%) 25 (100%)

Prognosis of whole patients pT1a Patients Recur pattern (N=521) Local or regional 4 N 3Yr DFS 5Yr DFS 5Yr OS 10 Yr OS Distant recurrence 7 267 98% 96% 100% 89% Bone 3 Liver 2 pT1b Lung 1 Distant LN 1 N 3Yr DFS 5Yr DFS 5Yr OS 10 Yr OS 254 97% 91% 97% 82%

Adjuvant Treatment effect In pT1a patients CTx N 3Yr DFS rate 5Yr DFS rate 5Yr OS rate 10 Yr OS rate No 234 98% 95% 100% 89% Yes 33 100% 100% 97% 97% Trastuzumab N 3Yr DFS rate 5Yr DFS rate 5Yr OS rate 10 Yr OS rate No 255 98% 95% 100% 89% Yes 12 100% NA 100% NA Adjuvant Treatment effect In pT1a, HR (+), patients CTx N 3Yr DFS rate 5Yr DFS rate 5Yr OS rate 10 Yr OS rate No 169 100% 100% 100% 85% Yes 21 100% 100% 99% NA Trastuzumab N 3Yr DFS rate 5Yr DFS rate 5Yr OS rate 10 Yr OS rate No 184 100% 100% 99% 85% Yes 6 100% NA 100% NA Adjuvant Treatment effect In pT1a, HR (-), patients CTx N 3Yr DFS rate 5Yr DFS rate 5Yr OS rate 10 Yr OS rate No 65 92% 84% 100% 100% Yes 12 100% 100% 100% NA Trastuzumab N 3Yr DFS rate 5Yr DFS rate 5Yr OS rate 10 Yr OS rate No 71 93% 85% 100% 100% Yes 6 100% NA NA NA

Adjuvant Treatment effect In pT1b patients P=0.237 P=0.838 CTx N 3Yr DFS rate 5Yr DFS rate 5Yr OS rate 7Yr OS rate No 139 95% 93% 96% 96% Yes 115 99% 88% 100% 100% P=0.691 P=0.454 Trastuzuamb N 3Yr DFS rate 5Yr DFS rate 5Yr OS rate 7 Yr OS rate No 229 99% 97% 97% 97% Yes 25 100% 100% 100% 100%

Adjuvant Treatment effect In pT1b, HR(+) patients P=0.346 P=0.160 CTx N 3Yr DFS rate 5Yr DFS rate 5Yr OS rate 7 Yr OS rate No 121 97% 97% 96% 96% Yes 71 98% 80% 100% 100% P=0.645 P=0.612 Trastuzumab N 3Yr DFS rate 5Yr DFS rate 5Yr OS rate 7 Yr OS rate No 180 99% 96% 97% 97% Yes 12 100% 100% 100% 100%

Adjuvant Treatment effect In pT1b, HR(-) patients OS not calculated (no event occurred) P=0.005 CTx N 3Yr DFS rate 5Yr DFS rate 5Yr OS rate 7 Yr OS rate No 18 87% 58% 100% 100% Yes 44 100% 100% 100% 100% OS not calculated P=0.42 (no event occurred) Trastuzumab N 3Yr DFS rate 5Yr DFS rate 5Yr OS rate 7 Yr OS rate No 49 95% 87% 100% 100% Yes 13 100% 100% 100% NA

Conclusion • Our result showed • Overall prognosis and treatment patterns of small(<1cm), node (-), and HER2+ breast cancer • Adjuvant chemotherapy was given to patients with • pT1b>T1a, HR-, Higher HG, NG • Adjuvant chemotherapy might be effective in patients with pT1b and HR(-) disease • Limitation: small sample size, retrospective data • Subsequent study with large sample size is warranted.