Dear Editor,
We appreciate Dr Atul Batra and Dr Akash Kumar for taking time to read our paper, and we thank the Editor for providing us an opportunity to make a response. Their comment helps us to further understand the prognostic significance of HER2 status in ER + breast cancer.
We agree that HER2 positivity predicted worse disease outcomes in breast cancer before the advent of anti-HER2 therapy such as trastuzumab [[1], [2], [3]]. However, clinical trials have demonstrated pronounced survival benefit of adding trastuzumab to standard chemotherapy in HER2+ patients [4]. Therefore, in the era of HER2-targeted therapy, prognostic role of HER2 status for ER + breast cancer warrants re-evaluation.
In the present clinical practice, trastuzumab is usually given concurrently with chemotherapy for HER2+ patients. Therefore, our prior report focused on ER + breast cancer patients at high risk to receive adjuvant chemotherapy, thus to reduce the bias of adjuvant chemotherapy treatment between HER2+ and HER2-groups. In current study, we found that ER+/HER2+ breast cancer patients treated with trastuzumab-based chemotherapy had superior outcome than ER+/HER2-patients receiving chemotherapy [5]. To thoroughly understand the prognostic value of HER2 status for ER + breast cancer, it is reasonable to compare the disease outcomes between ER+/HER2+ and ER+/HER2-patients irrespective of chemotherapy usage, thus to provide data about the question which Dr Atul Batra and Dr Akash Kumar asked. A total of 2137 patients were included from January 2009 to December 2015 in our center: 228 ER+/HER2+ patients (227 treated with chemotherapy) and 1909 patients with ER+/HER2-tumor (1079 treated with chemotherapy). After adjusting clinicopathological factors, multivariate analysis demonstrated that HER2 positivity was still associated with a superior DFS (HR 0.41, 95% CI: 0.23–0.71, P < 0.01) and OS (HR 0.39, 95% CI: 0.17–0.91, P = 0.03) compared with HER2 negativity in ER + breast cancer patients.
Taken together, our results indicated that, in the era of trastuzumab treatment, HER2 positivity itself should not be considered as an unfavorable factor for ER + patients.
References
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