Mueller Carolin, Rangan Rahul, Kruse Megan, Al-Hilli Zahraa
Outcomes Research Consortium, Department of Anesthesiology, Cleveland Clinic, Cleveland, OH, USA.
Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Ann Surg Oncol. 2025 May 13. doi: 10.1245/s10434-025-17430-6.
The treatment approach for small HER2-positive (+) breast cancers seeks to optimize efficacy while minimizing potential overtreatment and associated toxicities. This study aims to evaluate recent trends in treatment patterns for small HER2+ tumors.
Patients diagnosed with HER2+, cT1, cN0/pN0 breast cancer treated at a single institution from January 2018 to December 2022 were included. Clinicopathological, treatment, and follow-up data were collected and analyzed.
A total of 207 patients were included. Mean age was 63 (± 12.0) years. T category included cT1a in 12.1% (n = 25), cT1b in 28.0% (n = 58), and cT1c in 57.5% (n = 119), while 2.4% (n = 5) had clinical T1 category without further specification. Moreover, 74.4% (n = 154) were hormone receptor positive. Also, 66.7% (n = 138) received adjuvant therapy, 12.6% (n = 26) received neoadjuvant systemic therapy (NAT), and 12.1% (n = 25) received no systemic therapy. Administered regimens included: trastuzumab monotherapy in 6.1% (n = 10), taxane/trastuzumab in 55.5% (n = 91), taxane/carboplatin/trastuzumab in 18.9% (n = 31), and taxane/carboplatin/trastuzumab/pertuzumab in 15.2% (n = 25). In the 26 patients who received NAT, pathological complete response (pCR) was noted in 69.2% (n = 18). Overall, use of NAT increased from 2018 (7.1%) to 2021 (30.2%) and then decreased in 2022 (9.1%). The overall mastectomy rate was 35.3% (n = 73). Young age and multiple tumors were associated with a higher rate of mastectomy (age p < 0.001; multiple tumors p = 0.006). Upstaging of clinically node-negative patients occurred in 14.1% of patients at surgery.
The treatment for cT1N0 HER2+ breast cancers includes primary surgery with adjuvant HER2-targeted therapy in combination with chemotherapy. Primary surgery may allow for an opportunity to deescalate adjuvant therapy with no impact on surgical plan.
小的HER2阳性（+）乳腺癌的治疗方法旨在优化疗效，同时尽量减少潜在的过度治疗及相关毒性。本研究旨在评估小HER2+肿瘤治疗模式的近期趋势。
纳入2018年1月至2022年12月在单一机构接受治疗的诊断为HER2+、cT1、cN0/pN0乳腺癌的患者。收集并分析临床病理、治疗及随访数据。
共纳入207例患者。平均年龄为63（±12.0）岁。T分期中，cT1a占12.1%（n = 25），cT1b占28.0%（n = 58），cT1c占57.5%（n = 119），而2.4%（n = 5）为未进一步明确的临床T1期。此外，74.4%（n = 154）为激素受体阳性。66.7%（n = 138）接受辅助治疗，12.6%（n = 26）接受新辅助全身治疗（NAT），12.1%（n = 25）未接受全身治疗。所采用的方案包括：曲妥珠单抗单药治疗占6.1%（n = 十），紫杉烷/曲妥珠单抗占55.5%（n = 91），紫杉烷/卡铂/曲妥珠单抗占18.9%（n = 31），紫杉烷/卡铂/曲妥珠单抗/帕妥珠单抗占15.2%（n = 25）。在接受NAT的26例患者中，69.2%（n = 18）达到病理完全缓解（pCR）。总体而言，NAT的使用从2018年（占7.1%）增加到2021年（占30.2%），然后在2022年下降（占9.1%）。总体乳房切除术率为35.3%（n = 73）。年轻和多灶性肿瘤与更高的乳房切除术率相关（年龄p < 0.001；多灶性肿瘤p = 0.006）。14.1%的临床淋巴结阴性患者在手术时出现分期上调。
cT1N0 HER2+乳腺癌的治疗包括以HER2靶向治疗联合化疗进行辅助治疗的初次手术。初次手术可能为降低辅助治疗强度提供机会，且不影响手术计划。
