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Changing pattern of recurrences in patients with early HER2-positive breast cancer receiving neoadjuvant chemotherapy in the era of dual anti-HER2 therapy
  1. Joanne W Chiu1,
  2. Roland Leung1,
  3. Vikki Tang1,
  4. Wai Yin Cheuk2,
  5. Jessica Lo2,
  6. Gin Wai Kwok1,
  7. Hilda Wong1,
  8. Dacita Suen2,
  9. Polly Cheung3,
  10. Ting Ting Wong3,
  11. Thomas Yau1,
  12. Ava Kwong2,3
  1. 1 Department of Medicine, Queen Mary Hospital, Hong Kong, China
  2. 2 Department of Surgery, Queen Mary Hospital, Hong Kong, China
  3. 3 Department of Surgery, Hong Kong Sanatorium Hospital, Hong Kong, China
  1. Correspondence to Dr Ava Kwong, Department of Surgery, Queen Mary Hospital, Hong Kong 518031, China; avakwong{at}


Background Over the last 10 years, there has been a major treatment revolution for early human epidermal growth factor receptor 2 (HER2)–positive breast cancer. We aimed to explore the outcome of different neoadjuvant chemotherapy in a tertiary breast cancer centre with early HER2-positive breast cancer as well as factors associated with pathological complete response (pCR) and recurrence-free survival (RFS). The pattern of recurrence was also studied.

Methods This retrospective study analysed the outcome of neoadjuvant chemotherapy during the period 2005 to 2016 in a tertiary referral centre in Hong Kong. Patients were divided into three groups according to the neoadjuvant chemotherapy they received: chemotherapy only (Chemo), chemotherapy plus trastuzumab (Chemo-H) and chemotherapy plus double anti-HER2 therapy (Chemo-DH).

Results There were 226 cases analysed during the study period. The rate of pCR was 5%, 26% and 60% in Chemo, Chemo-H and Chemo-DH groups, respectively (Chemo vs pooled Chemo-H/DH: p<0.0001; Chemo-H vs Chemo-DH: p<0.0001). This was accompanied by a trend of increased rate of breast conservation therapy in Chemo-DH cohort (p=0.046). Use of double anti-HER2 therapy, older age (>50 years) and hormone receptor negativity were associated with more pCR. pCR was associated with better RFS. Among those with recurrence, the proportion of patients with brain as the only site of recurrence increased remarkably with more efficacious anti-HER2 treatment (0% in Chemo, 8% in Chemo-H, 67% in Chemo-DH).

Conclusion pCR remains an important predictive factor for improved RFS. In the era of dual anti-HER2 neoadjuvant therapy, brain-only recurrence poses a challenge to disease surveillance and treatment.

  • early breast cancer
  • neoadjuvant chemotherapy
  • HER2-positive
  • pathologic complete response
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  • Contributors JWC, RL, GWK, HW, DS, PC, TTW, TY and AK provided patients. JWC, RL, HW, TY and AK formulated the research goals and aims. JWC, VT, WYC and JL collected the data. JWC and VT designed the methodology, wrote the initial draft and prepared the data presentation. VT maintained research data and performed statistical analysis. JWC, VT, HW and TY reviewed and edited the manuscript. JWC, TY and AK oversaw the study. All authors approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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