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Pertuzumab/Trastuzumab/CT Versus Trastuzumab/CT Therapy for HER2+ Breast Cancer: Results from the Prospective Neoadjuvant Breast Registry Symphony Trial (NBRST)

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Pertuzumab became a standard part of neoadjuvant therapy for human epidermal growth factor receptor 2-positive (HER2+) breast cancers approximately halfway through Neoadjuvant Breast Registry Symphony Trial (NBRST) enrollment, providing a unique opportunity to determine biologically which clinical HER2+ patients benefit most from dual targeting. As a neoadjuvant phase 4 study, NBRST classifies patients by both conventional and molecular subtyping.

Methods

Of 308 clinical HER2+ patients enrolled in NBRST between 2011 and 2014 from 62 U.S. institutions, 297 received neoadjuvant chemotherapy (NCT) with HER2-targeted therapy and underwent surgery. This study compared the pathologic complete response (pCR) rate of BluePrint versus clinical subtypes with treatment, specifically differences between trastuzumab (T) treatment and trastuzumab and pertuzumab (T/P) treatment.

Results

In this study, 60% of the patients received NCT-T, and 40% received NCT-T/P. The overall pCR rate (ypT0/isN0) was 47%. BluePrint classified 161 tumors (54%) as HER2 type, with a pCR rate of 65%. This was significantly higher than the pCR rate for the 91 HER2+ tumors (31%) classified as luminal (18%) (p = 0.00001) and the 45 tumors (15%) classified as basal (44%) (p = 0.0166). The patients treated with T/P had higher pCR rates than those treated with trastuzumab alone. The difference was most pronounced in the BluePrint luminal patients (8 vs. 31%). The highest pCR was reached by the BluePrint HER2-type patients treated with T/P (76%).

Conclusions

The addition of pertuzumab leads to increased pCR rates for all HER2+ patient groups except for the BluePrint basal-type patients. This better response was most pronounced for the BluePrint luminal-type patients.

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Acknowledgement

We are grateful to all the women who participated in this study and all the investigators, surgeons, pathologists, and research nurses. The study was sponsored by Agendia. The authors also thank Erin Yoder (Agendia Inc.) for data management support.

Disclosure

Femke de Snoo and Lisette Stork-Sloots were employees of Agendia at the time of the analysis and are consultants to Agendia for this work. Pat Whitworth and Peter Beitsch received honoraria from Agendia.

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Authors and Affiliations

  1. Targeted Medical Education, Dallas Breast Center, 8140 Walnut Hill Lane, Suite 800, Dallas, TX, 75231, USA

    Peter Beitsch MD

  2. Targeted Medical Education, Nashville Breast Center, Nashville, TN, USA

    Pat Whitworth MD & Paul Baron MD

  3. Breast & Melanoma Specialists of Charleston, Charleston, SC, USA

    Michael C. Rotkis MD

  4. Northern Indiana Cancer Research Consortium, South Bend, IN, USA

    Angela M. Mislowsky MD

  5. Coastal Carolina Breast Center, Murrells Inlet, SC, USA

    Paul D. Richards MD

  6. Blue Ridge Cancer Care, Roanoke, VA, USA

    Mary K. Murray MD

  7. Cleveland Clinic Akron General, Akron, OH, USA

    James V. Pellicane MD

  8. Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA, USA

    Carrie L. Dul MD

  9. St. John Region, Grosse Pointe Woods, MI, USA

    Charles H. Nash MD

  10. Northeast Georgia Medical Center, Gainesville, GA, USA

    Lisette Stork-Sloots MSc & Femke de Snoo MD, PhD

  11. Agendia Inc., Irvine, CA, USA

    Sarah Untch BS

  12. Comprehensive Cancer Center, Palm Springs, CA, USA

    Laura A. Lee MD

Authors
  1. Peter Beitsch MD
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  2. Pat Whitworth MD
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  3. Paul Baron MD
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  4. Michael C. Rotkis MD
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  5. Angela M. Mislowsky MD
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  6. Paul D. Richards MD
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  7. Mary K. Murray MD
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  8. James V. Pellicane MD
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  9. Carrie L. Dul MD
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  10. Charles H. Nash MD
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  11. Lisette Stork-Sloots MSc
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  12. Femke de Snoo MD, PhD
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  13. Sarah Untch BS
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  14. Laura A. Lee MD
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Corresponding author

Correspondence to Peter Beitsch MD.

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Beitsch, P., Whitworth, P., Baron, P. et al. Pertuzumab/Trastuzumab/CT Versus Trastuzumab/CT Therapy for HER2+ Breast Cancer: Results from the Prospective Neoadjuvant Breast Registry Symphony Trial (NBRST). Ann Surg Oncol 24, 2539–2546 (2017). https://doi.org/10.1245/s10434-017-5863-x

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  • DOI: https://doi.org/10.1245/s10434-017-5863-x

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