Dissecting the effect of hormone receptor status in patients with HER2-positive early breast cancer: exploratory analysis from the ALTTO (BIG 2-06) randomized clinical trial

Matteo Lambertini, Christine Campbell, Richard D. Gelber, Giuseppe Viale, Ann Elizabeth McCullough, Florentine Hilbers, Larissa A. Korde, Olena Werner, Saranya Chumsri, Christian Jackisch, Antonio C. Wolff, Ines Vaz-Luis, Arlindo R. Ferreira, Aleix Prat, Alvaro Moreno-Aspitia, Martine Piccart, Sherene Loi, Evandro de Azambuja

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Purpose: Limited evidence exists on the impact of hormone receptor (HR) status to counsel HER2-positive early breast cancer patients receiving adjuvant anti-HER2 therapy. Methods: ALTTO (BIG 2-06) was an international, intergroup, open-label, randomized phase III trial in HER2-positive early breast cancer patients randomized to receive 1 year of trastuzumab and/or lapatinib. HER2, estrogen and progesterone receptors were centrally tested for all patients. We investigated the impact of HR status on prognosis, risk of disease-free survival (DFS) events over time, patterns of first DFS events, and factors associated with risk of DFS events overall, in years 0–5 and 6–8. Results: Out of 6273 patients included in this analysis, 3603 (57.4%) had HR-positive tumors. Median follow-up was 6.93 years. Five-year and 8-year DFS were 86% and 80% in patients with HR-positive disease, and 83% and 79% in those with HR-negative tumors, respectively. Mean annual hazards of recurrence in years 0–5 were 3% in patients with HR-positive disease and 4% in those with HR-negative tumors, while in years 6–8 they were 3% and 2%, respectively. Distribution of first DFS event in years 6–8 (P = 0.005) and type of first distant recurrence (P < 0.001) were significantly different between the two groups. Risk factors for DFS events overall, in years 0–5, and 6–8 were different in patients with HR-positive and HR-negative tumors. Conclusions: HER2-positive early breast cancer is characterized by the presence of two diseases with distinct natural history based on HR status requiring the development of different follow-up strategies and future de-escalation and escalation clinical trials.

Original languageEnglish (US)
Pages (from-to)103-114
Number of pages12
JournalBreast Cancer Research and Treatment
Volume177
Issue number1
DOIs
StatePublished - Aug 30 2019

Keywords

  • Breast cancer
  • Estrogen receptor
  • HER2
  • Progesterone receptor

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Lambertini, M., Campbell, C., Gelber, R. D., Viale, G., McCullough, A. E., Hilbers, F., Korde, L. A., Werner, O., Chumsri, S., Jackisch, C., Wolff, A. C., Vaz-Luis, I., Ferreira, A. R., Prat, A., Moreno-Aspitia, A., Piccart, M., Loi, S., & de Azambuja, E. (2019). Dissecting the effect of hormone receptor status in patients with HER2-positive early breast cancer: exploratory analysis from the ALTTO (BIG 2-06) randomized clinical trial. Breast Cancer Research and Treatment, 177(1), 103-114. https://doi.org/10.1007/s10549-019-05284-y