Breast cancer is the most common cancer globally, with a significant proportion occurring in premenopausal women, particularly in China. Hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-positive breast cancer presents distinct molecular characteristics and therapeutic responses, complicating treatment decisions. Although trastuzumab has improved outcomes, the role of ovarian function suppression (OFS) in this subset remains unclear.
Previous studies like SOFT and ASTRRA primarily focused on HR-positive/HER2 patients, with a limited representation of HR-positive/HER2-positive cases and few receiving trastuzumab. This knowledge gap sparked debate on the value of OFS in trastuzumab-treated premenopausal patients with HR-positive/HER2-positive breast cancer.
Data from 253 premenopausal patients with HR-positive/HER2-positive breast cancer who received trastuzumab from 2009 to 2018 were analyzed. The study investigated the efficacy of OFS therapy in premenopausal women with HR-positive/HER2-positive early-stage breast cancer who received trastuzumab treatment—the research aimed to identify patients who could benefit from OFS and explore clinicopathological factors influencing prognosis.
The study found that adding aromatase inhibitors to tamoxifen/toremifene plus OFS significantly improved invasive disease-free survival (IDFS) compared with tamoxifen/toremifene alone. Subgroup analysis showed more significant benefits in patients with lymph node involvement and those aged ≤40 years. Independent prognostic factors for IDFS included age, histological grade, lymph node status, progesterone receptor (PR) expression, and OFS treatment.
The study’s findings suggest that HER2 positivity alone warrants OFS in premenopausal HR-positive breast cancer, especially in high-risk subgroups like lymph node-positive patients and those aged ≤40 years. However, the decision to include OFS should consider individual patient characteristics.
Clinicopathological factors like age, histological grade, PR status, lymph node involvement, and OFS treatment independently influenced IDFS. Based on these factors, a prognostic nomogram was developed to guide treatment decisions and risk stratification in HR-positive/HER2-positive patients receiving trastuzumab.
Limitations include the retrospective nature of the study, potential biases, and the need for longer follow-up to assess treatment benefits holistically. Future prospective research should validate these findings in larger cohorts and integrate multiomics data for improved predictive modeling.
In conclusion, the study provides real-world evidence supporting the use of OFS in premenopausal HR-positive/HER2-positive breast cancer patients receiving trastuzumab.
The study’s results underscore the importance of individualized treatment decisions based on clinicopathological factors and highlight the need for further research to refine predictive models in this population.1
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