ABSTRACT
Introduction
: The potential benefit of systemic therapy in patients with T1a HER2+ cancers is
not well understood, and no consensus guidelines exist. We sought to investigate practice
patterns of chemotherapy use in this population.
Methods
: From the National Cancer Database (2013-2018), we identified female patients with
HER2+ cancers staged as cT1aN0 or pT1aN0 and stratified by receipt of chemotherapy.
Using univariate and multivariable analyses we assessed the clinicopathologic features
associated with the receipt of chemotherapy. We also compared rates of overall survival
(OS).
Results
: Of 5,176 women with cT1aN0 HER2+ cancers, 88 (2%) received neoadjuvant chemotherapy.
Younger age and hormone-receptor (HR) negative tumors were factors independently associated
with receipt of neoadjuvant chemotherapy (all p<0.001). Of 11,688 women with pT1aN0
HER2+ cancers, 5,588 (48%) received adjuvant chemotherapy. Rates of use increased
over the analysis period from 39% in 2013 to 53% in 2018 (p<0.001). Factors independently
associated with receipt of adjuvant chemotherapy included younger age, having a poorly
differentiated tumor, exhibiting lymphovascular invasion, undergoing adjuvant radiation
(all p<0.001). There were no differences in OS when comparing those who did and did
not receive chemotherapy in either group.
Conclusions
: The use of chemotherapy in patients with HER2+ T1a cancers is increasing over time
and is, as expected, more common among patients with unfavorable clinicopathologic
features. Since no prognostic algorithm currently exists, more prospective data is
needed to understand which of these patients may derive benefit from systemic therapy
and which may safely avoid the morbidity of chemotherapy.
Keywords
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Article Info
Publication History
Accepted:
July 24,
2022
Received in revised form:
July 19,
2022
Received:
May 18,
2022
Editor: Dr K KalinskyPublication stage
In Press Journal Pre-ProofFootnotes
Accepted for presentation in poster format at the 23rd Annual Meeting of the American Society of Breast Surgeons, April 2022.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
