HER2 and Choice of Adjuvant Chemotherapy for Invasive Breast Cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-15 (original) (raw)

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Affiliations of authors: S. Paik, C. Park, Division of Pathology, National Surgical Adjuvant Breast and Bowel Project (NSABP), Allegheny General Hospital, Pittsburgh, PA; J. Bryant, NSABP and Departments of Statistics and Biostatistics, University of Pittsburgh; E. Tan-Chiu, D. L. Wickerham, N. Wolmark, NSABP Operations Center, Pittsburgh; G. Yothers, NSABP and Department of Statistics, University of Pittsburgh.

Correspondence to: Soonmyung Paik, M.D., Division of Pathology, National Surgical Adjuvant Breast and Bowel Project, East Commons Professional Bldg., Four Allegheny Center–5th Floor, Pittsburgh, PA 15212–5234 (e-mail: soon.paik@nsabp.org).

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Affiliations of authors: S. Paik, C. Park, Division of Pathology, National Surgical Adjuvant Breast and Bowel Project (NSABP), Allegheny General Hospital, Pittsburgh, PA; J. Bryant, NSABP and Departments of Statistics and Biostatistics, University of Pittsburgh; E. Tan-Chiu, D. L. Wickerham, N. Wolmark, NSABP Operations Center, Pittsburgh; G. Yothers, NSABP and Department of Statistics, University of Pittsburgh.

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Affiliations of authors: S. Paik, C. Park, Division of Pathology, National Surgical Adjuvant Breast and Bowel Project (NSABP), Allegheny General Hospital, Pittsburgh, PA; J. Bryant, NSABP and Departments of Statistics and Biostatistics, University of Pittsburgh; E. Tan-Chiu, D. L. Wickerham, N. Wolmark, NSABP Operations Center, Pittsburgh; G. Yothers, NSABP and Department of Statistics, University of Pittsburgh.

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Affiliations of authors: S. Paik, C. Park, Division of Pathology, National Surgical Adjuvant Breast and Bowel Project (NSABP), Allegheny General Hospital, Pittsburgh, PA; J. Bryant, NSABP and Departments of Statistics and Biostatistics, University of Pittsburgh; E. Tan-Chiu, D. L. Wickerham, N. Wolmark, NSABP Operations Center, Pittsburgh; G. Yothers, NSABP and Department of Statistics, University of Pittsburgh.

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Affiliations of authors: S. Paik, C. Park, Division of Pathology, National Surgical Adjuvant Breast and Bowel Project (NSABP), Allegheny General Hospital, Pittsburgh, PA; J. Bryant, NSABP and Departments of Statistics and Biostatistics, University of Pittsburgh; E. Tan-Chiu, D. L. Wickerham, N. Wolmark, NSABP Operations Center, Pittsburgh; G. Yothers, NSABP and Department of Statistics, University of Pittsburgh.

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Affiliations of authors: S. Paik, C. Park, Division of Pathology, National Surgical Adjuvant Breast and Bowel Project (NSABP), Allegheny General Hospital, Pittsburgh, PA; J. Bryant, NSABP and Departments of Statistics and Biostatistics, University of Pittsburgh; E. Tan-Chiu, D. L. Wickerham, N. Wolmark, NSABP Operations Center, Pittsburgh; G. Yothers, NSABP and Department of Statistics, University of Pittsburgh.

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Affiliations of authors: S. Paik, C. Park, Division of Pathology, National Surgical Adjuvant Breast and Bowel Project (NSABP), Allegheny General Hospital, Pittsburgh, PA; J. Bryant, NSABP and Departments of Statistics and Biostatistics, University of Pittsburgh; E. Tan-Chiu, D. L. Wickerham, N. Wolmark, NSABP Operations Center, Pittsburgh; G. Yothers, NSABP and Department of Statistics, University of Pittsburgh.

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Revision received:

02 October 2000

Accepted:

05 October 2000

Published:

20 December 2000

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Soonmyung Paik, John Bryant, Elizabeth Tan-Chiu, Greg Yothers, Chanheun Park, D. Lawrence Wickerham, Norman Wolmark, HER2 and Choice of Adjuvant Chemotherapy for Invasive Breast Cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-15, JNCI: Journal of the National Cancer Institute, Volume 92, Issue 24, 20 December 2000, Pages 1991–1998, https://doi.org/10.1093/jnci/92.24.1991
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Abstract

Background: Recent retrospective analyses have suggested that breast cancer patients whose tumors overexpress HER2 derive preferential benefit from treatment with anthracyclines such as doxorubicin. This has led some clinicians to propose that HER2 should be used as a predictive marker in choosing between anthracycline-based regimens and combination chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil (CMF). We evaluated this recommendation in a retrospective study of National Surgical Adjuvant Breast and Bowel Project Protocol B-15, in which patients received a combination of doxorubicin and cyclophosphamide (AC), CMF, or AC followed by CMF. We hypothesized that AC would be superior to CMF only in the HER2-positive patients. Methods: Immunohistochemical detection of HER2 was performed on tumor sections from 2034 of 2295 eligible patients. We used statistical analysis to evaluate the interaction between the efficacy of the assigned treatments and HER2 overexpression. All statistical tests were two-sided. Results: Tumor sections from 599 patients (29%) stained positive for HER2. AC was superior to CMF in HER2-positive patients only, although differences in outcomes did not reach statistical significance. In the HER2-positive cohort, relative risks of failure (i.e., after AC treatment as compared with CMF treatment) were 0.84 for disease-free survival (DFS) (95% confidence interval [CI] = 0.65–1.07; P = .15), 0.82 for survival (95% CI = 0.63–1.06; P = .14), and 0.80 for recurrence-free survival (RFS) (95% CI = 0.62–1.04; P = .10). Tests for interaction between treatment and HER2 status were suggestive but not statistically significant (P = .19 for DFS, P = .11 for survival, and P = .08 for RFS). Conclusions: These results, together with overview results indicating minor overall superiority for anthracycline-based regimens relative to CMF, indicate a preference for the AC regimen in patients with HER2-positive tumors. Both AC and CMF regimens may be considered for patients with HER2-negative tumors.

© Oxford University Press

Topic:

• doxorubicin
• immunologic adjuvants
• pharmaceutical adjuvants
• genes, erbb-2
• intestines
• receptor, erbb-2
• surgical procedures, operative
• breast
• neoplasms
• protein overexpression
• her2 positive
• her2 negative

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