J Breast Cancer.  2018 Dec;21(4):415-424. 10.4048/jbc.2018.21.e53.

Clinical Differences in Triple-Positive Operable Breast Cancer Subtypes in Korean Patients: An Analysis of Korean Breast Cancer Registry Data

• You SH
• Chae BJ
• Eom YH
• Yoo TK
• Kim YS
• Kim JS
• Park WC

• KMID: 2429820
• DOI: http://doi.org/10.4048/jbc.2018.21.e53

Abstract

PURPOSE
Triple-positive breast cancer is defined by estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) positivity. Several systemic breast cancer therapies target hormonal and HER2 responsiveness. We compared clinical outcomes of triple-positive disease with those of HER2-enriched and luminal HER2-negative disease and investigated the clinical efficacy of anti-HER2 therapy for triple-positive disease.
METHODS
We retrospectively compared overall and recurrence-free survival among cases included in the Korean Breast Cancer Society (KBCS) and Seoul St. Mary's Hospital breast cancer registries and the therapeutic efficacy of trastuzumab for triple-positive and HER2-enriched cases.
RESULTS
KBCS registry data (2006-2010; median follow-up, 76 months) indicated that patients with triple-positive breast cancer had intermediate survival between those with luminal A and HER2-enriched subtypes (p < 0.001). Trastuzumab did not improve overall survival among patients with triple-positive breast cancer (p=0.899) in contrast to the HER2-enriched subtype (p=0.018). Seoul St. Mary's Hospital registry data indicated similar recurrence-free survival outcomes (p < 0.001) and a lack of improvement with trastuzumab among patients with triple-positive breast cancer (median follow-up, 33 months; p=0.800). Multivariate analysis revealed that patients with triple-positive breast cancer had better overall survival than those with HER2-enriched disease and similar survival as those with the luminal A subtype (triple-positive: hazard ratio, 1.258, p=0.118; HER2-enriched: hazard ratio, 2.377, p < 0.001).
CONCLUSION
Our findings showed that anti-HER2 therapy was less beneficial for treatment of triple-positive breast cancer than for HER2-enriched subtypes of breast cancer, and the triple-positive subtype had a distinct prognosis.

Keyword

Breast neoplasms; ErbB-2 receptor; Estrogen receptors; Hormones; Trastuzumab

MeSH Terms

Breast Neoplasms*
Breast*
Estrogens
Follow-Up Studies
Humans
Multivariate Analysis
Phenobarbital
Prognosis
Receptor, Epidermal Growth Factor
Receptor, ErbB-2
Receptors, Estrogen
Receptors, Progesterone
Registries
Retrospective Studies
Seoul
Trastuzumab
Treatment Outcome
Estrogens
Phenobarbital
Receptor, Epidermal Growth Factor
Receptor, ErbB-2
Receptors, Estrogen
Receptors, Progesterone
Trastuzumab

Figure

• 

  Figure 1 Schematic diagram of the study cohorts, intrinsic subtype distributions, and list of study endpoints.CMC=Seoul St. Mary's Hospital of the Catholic Medical Center; KBCS=Korean Breast Cancer Society; TNBC=triple-negative breast cancer; RFS=recurrence-free survival; Lum-A=luminal A subtype; HER2=human epidermal growth factor receptor 2; OS=overall survival.

• 

  Figure 2 Survival outcomes of patients with triple-positive, luminal A, and human epidermal growth factor receptor 2 (HER2)-enriched breast cancer. (A) Recurrence-free survival (RFS) among the intrinsic subtypes. Data were obtained from the cohort of Seoul St. Mary's Hospital of the Catholic Medical Center. (B) Overall survival (OS) among intrinsic subtypes in the Korean Breast Cancer Society cohort (2006–2010). (C) OS among intrinsic subtypes in the Korean Breast Cancer Society cohort (2006–2010). Patients not treated with anti-HER2 therapy in the triple-positive and HER2-enriched groups.TNBC=triple-negative breast cancer.

• 

  Figure 3 Overall survival (OS) among luminal A, triple-positive, human epidermal growth factor receptor 2 (HER2)-enriched and triple-negative breast cancer (TNBC) subtypes in the Korean Breast Cancer Society cohort (2006–2010), according to the 7th edition of the American Joint Committee on Cancer staging system for breast cancer. OS was estimated using Kaplan-Meier survival analysis. (A) Stage I, (B) stage II, (C) stage III, and (D) stage IV.

• 

  Figure 4 Efficacy of trastuzumab for triple-positive breast cancer in the Korean Breast Cancer Society cohort (2006–2010). Cases were staged according to the 7th edition of the American Joint Committee on Cancer staging system for breast cancer. Overall survival (OS) was estimated using Kaplan-Meier survival analysis. (A) Stage I, (B) stage II, (C) stage III, and (D) stage IV.

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