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Annals of Oncology Advance Access published online on July 29, 2008
Annals of Oncology, doi:10.1093/annonc/mdn427
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© The Author 2008. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Hormone receptor status and pathologic response of HER2-positive breast cancer treated with neoadjuvant chemotherapy and trastuzumab

F. Peintinger1,2, A. U. Buzdar3, H. M. Kuerer1, J. A. Mejia3, C. Hatzis4, A. M. Gonzalez-Angulo3, L. Pusztai3, F. J. Esteva3, S. S. Dawood3, M. C. Green3, G. N. Hortobagyi3 and W. F. Symmans2,*

1 Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston
2 Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston
3 Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston
4 Department of Environmental Health, Nuvera Biosciences, Inc., Woburn, USA

* Correspondence to: Dr W. F. Symmans, Department of Pathology, Unit 85, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA. Tel: +1-713-792-7962; Fax: +1-713-745-3740; E-mail: fsymmans{at}mdanderson.org

Background: The aim of this study was to compare the extent of pathologic response in patients with HER2-positive (HER2+) breast cancer treated with standard neoadjuvant chemotherapy, with or without trastuzumab (H), according to hormone receptor (HR) status.

Patients and methods: We included 199 patients with HER2+ breast cancer from three successive cohorts of neo-adjuvant chemotherapy on the basis of paclitaxel (Taxol) (P) administered weekly (w) or three weekly (3-w), followed by 5-fluorouracil (F), doxorubicin (A) or epirubicin (E), and cyclophosphamide (C). Residual cancer burden (RCB) was determined from pathologic review of the primary tumor and lymph nodes and was classified as pathologic complete response (pCR) or minimal (RCB-I), moderate (RCB-II), or extensive (RCB-III) residual disease.

Results: In HR-positive (HR+) cancers, a higher rate of pathologic response (pCR/RCB-I) was observed with concurrent H + 3-wP/FEC (73%) than with 3-wP/FEC (34%, P = 0.002) or wP/FAC (47%; P = 0.02) chemotherapy alone. In HR-negative (HR–) cancers, there were no significant differences in the rate of pathologic response (pCR/RCB-I) from 3-wP/FAC (50%), wP/FAC (68%), or concurrent H + 3-wP/FEC (72%).

Conclusions: Patients with HR+/HER2+ breast cancer obtained significant benefit from addition of trastuzumab to P/FEC chemotherapy; pathologic response rate was similar to that seen in HR–/HER2+ breast cancers.

breast cancer, HER2, hormone receptor status, neoadjuvant chemotherapy, trastuzumab

Received for publication March 8, 2008. Revision received June 18, 2008. Accepted for publication June 19, 2008.


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