Clinical outcomes and metastatic behavior between de novo versus recurrent HER2-positive metastatic breast cancer: A 17-year single-institution cohort study at Taipei Veterans General Hospital

Abstract

Background: To assess the clinical outcomes and metastatic behavior between de novo versus recurrent human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) based on a single-institution database in Taiwan. Methods: We retrospectively identified patients diagnosed between January 2000 and December 2017 with de novo stage IV or recurrent HER2-positive MBC. Several variables were recorded in patients with recurrent disease: age at diagnosis, metastatic site, hormone receptor (HR) status, HER2 status, and disease-free interval (DFI). Treatments and metastatic patterns were compared between de novo stage IV and recurrent MBC cohorts. Post-metastasis survival (PMS) was estimated using the Kaplan-Meier method with log-rank tests. Hazard ratios and 95% CIs were estimated using Cox regression analysis. Results: In total, 1360 patients were diagnosed with breast cancer with HER2 overexpression. At baseline, de novo stage IV patients were older than recurrent MBC patients (median age 58 vs 53). The majority of the de novo stage IV patients were diagnosed after 2010, while most of the recurrent MBC patients were diagnosed during 2000-2009. An increased number of de novo stage IV patients underwent targeted therapy than recurrent MBC patients was also noted. PMS in patients with de novo stage IV and recurrent MBC was 79.2 months and 61.8 months, respectively, which indicated significant better survival in de novo stage IV than those with recurrent MBC disease. Longer survival was also noted in de novo stage IV and recurrent MBC with DFI >24 months than in those with recurrent MBC with DFI <24 months and in patients receiving HER2-targeted therapy after MBC diagnosis than in those not receiving the therapy. However, median PMS showed no significant difference between patients with the luminal B2 (HR-positive, HER2-negative) and HER2-enriched (HR-negative, HER2-positive) subtypes. After adjustment in multivariate analysis, a low risk of BC-specific death was observed in patients aged >50 years, those receiving HER2-targeted therapy for MBC, and those with oligometastasis, while patients with first metastases to the liver or brain showed a higher risk of BC-specific death than those without metastases. Conclusion: De novo and recurrent MBC have distinct characteristic, metastatic patterns and outcomes in Asian HER2-positive breast cancer patients. The age distribution and survivals between HR+/– status were different to non-Asian group. These differences should be further investigated in the future considering ethnic factor.

Winners of the 2022 honor awards for excellence at the annual meeting of the Chinese Medical Association-Taipei: Part I

“…As expected, the recurrent BC patients having a good response to the therapy with prolonged DFS (>24 months) also resulted in a longer and better PMS compared to those with DFS < 24 months. 3 The present study reminded us that an active and individualized/molecular based therapy may improve the outcome of advanced-stage cancer patients, even for those recurrent cancer patients. Similar to other cancer treatment, 13,15 with far advanced technology and precise medicine guided therapy, the patients may have a better chance for prolonging their life.…”

“…The present editorial is a "Part I," including three excellent works. [1][2][3] We are honored to present three winners and summary their impressive, scientific and useful findings, which bring a great impact on global health promotion and offer a better care reference for the profession in the management of various kinds of patients with similar clinical situation in the future.…”

“…12,13 The other study entitled "Clinical outcomes and metastatic behavior between de novo versus recurrent HER2-positive metastatic breast cancer: A 17-year single-institution cohort study at Taipei Veterans General Hospital" was conducted by Dr Cheng and her colleagues. 3 Similar to management of all other types of cancers, 2,8,10,11,13 therapy of breast cancer (BC) is usually a multimodality approach, which consists of surgery, radiotherapy, hormone therapy, chemotherapy, immunotherapy, and targeted therapy. Among these, immunotherapy and targeted therapy may offer a new chance to overcome the troublesome BC patients, either advanced-stage or recurrent BC or BC with aggressive behaviors by improving the outcome and prolonging life.…”

“…This research focused on the characteristics and outcomes of de novo stage IV (n = 97) or recurrent (n = 126) HER2-positive BC. 3 Although advanced stage and recurrent cancers are often grouped together based on the challenge of therapy (absence of effective therapeutic choice) and very poor outcomes, 15 the real difference between two is still seldom investigated. We are happy to learn the authors attempted to respond to the above.…”

“…14 HER2-positive BC was an example since it is often associated with poor outcomes compared to other subtypes of BC patients. 3 Fortunately, introducing trastuzumab as an agent for BC, the prognosis of HER2-positive BC is markedly improved thereafter. This research focused on the characteristics and outcomes of de novo stage IV (n = 97) or recurrent (n = 126) HER2-positive BC.…”