KEY TAKEAWAYS
- The NBRST trial aimed to evaluate H1/H2 risk as a biomarker for chemosensitivity and 5-year DMFS in NCT-treated pts from NBRST.
- Pts with HR+HER2-, MP High-Risk tumors were stratified into H1 or H2 groups and compared for pCR and DMFS.
- The study predicted pCR in HR+HER2- breast cancer, with H2 tumors more chemosensitive but having worse outcomes if residual disease remains, suggesting immune therapy may be beneficial.
HR+HER2- early-stage breast cancer is a diverse disease that is less responsive to neoadjuvant chemotherapy than other types of breast cancer. Genomic profiling can help doctors decide which neoadjuvant treatments are best for each patient by predicting how likely they are to achieve a complete pathological complete response (pCR) or be sensitive to chemotherapy.
Researchers aimed to evaluate H1/H2 risk as a biomarker for chemosensitivity and 5-year DMFS in NCT-treated patients(pts) from NBRST.
The study involved 1,069 early-stage breast cancer pts who underwent neoadjuvant therapy. Specifically, focused on 327 pts with HR+HER2- breast cancer and MammaPrint High-Risk scores. These pts were further categorized into two groups, which were H1 (score ≤ 0, > -0.57) and H2 (score ≤ -0.57). The analysis compared the pathologic complete response (pCR) rates between these MammaPrint High-Risk subgroups using a two-sided proportional z-test. Disease-free survival (DMFS) differences were assessed through Kaplan-Meier analysis and the log-rank test.
The study classified 198 (61%) pts with H1 tumors and 129 (39%) with H2 tumors. Age, tumor stage, and lymph node status were comparable between both groups. There was a higher proportion of Grade 3 tumors in the H2 group. A significantly higher percentage of pCR was achieved in H2 tumors (30/129; 23%) vs. H1 tumors (12/198; 6.1%) (P< 0.001). The median follow-up was 5.3 years. The 5-year DMFS (%, [95% CI]) was significantly worse for pts with H2 tumors (64.8 [55.9 – 75.1]), with most events occurring early (< 3 years), compared with H1 tumors (77.1 [70.4 – 84.3]; P = 0.012). Pts with H1 tumors that achieved pCR had improved 5-year DMFS (81.8 [61.9 – 100]) compared to H1 tumors that did not achieve pCR (76.8 [69.9 – 84.4]; P = 0.009). Pts with H2 tumors that had a pCR demonstrated significantly better 5-year DMFS (80.7 [65.3 – 99.8]) than pts with residual disease (60.2 [50.1 – 72.4]; P= 0.009).
The study predicted pCR in HR+HER2- breast cancer, with H2 tumors more chemosensitive but having worse outcomes if residual disease remains, suggesting immune therapy may be beneficial.
Source: https://ascopubs.org/doi/abs/10.1200/JCO.2023.41.16_suppl.521?af=R
Clinical Trial: https://classic.clinicaltrials.gov/ct2/show/NCT01479101
Peter D. Beitsch, James V. Pellicane, Lajos Pusztai, Paul Baron, Erin Frances Cobain, Mary K. Murray, Andrew Ashikari, Pond R. Kelemen, Angela Marie Mislowsky, Julie Barone, Kenneth H. Cowan, Rakhshanda Layeequr Rahman, William C. Dooley, Andrea Menicucci, Christine Finn, M. William William Audeh, Pat W. Whitworth, and NBRST Investigators Group. DOI: 10.1200/JCO.2023.41.16_suppl.521 Journal of Clinical Oncology 41, no. 16_suppl (June 01, 2023) 521-521.
