Outcomes of chemotherapy/trastuzumab treated locally advanced HER2+ breast cancer in British Columbia between 2005 and 2010.
Bibliographic record
Abstract
e12079 Background: Adding trastuzumab (T) to chemotherapy (CT) improves HER2+ breast cancer (BC) outcomes. With the exception of the NOAH study, neoadjuvant (neo) and adjuvant (adj) trials enrolled few patients (pts) with locally advanced (LA) disease. We performed a retrospective analysis in LA HER2+ BC to better understand prognosis in this disease. Methods: Using the BC Outcomes Unit database, we identified all pts referred to the British Columbia Cancer Agency with clinically (c) LA HER2+ BC between 05/2005 and 12/2010, who received standard neo or adj CT/T. LA was defined as T4Nany, T3N1-3, TanyN2-3. Adj cases with c but not pathological (p) LA stage were excluded. Five-year (5 y) relapse free survival (RFS) and BC specific survival (BCSS) were estimated for the overall cohort, by hormone receptor (HR) status, for neo and adj CT/T, and by pathologic complete response (pCR) in neoadj cases. Results: We identified 380 cases. Median follow up was 6.4 y. Adj (258) and neo (122) cases differed in HR- status (35% vs 43%), inflammatory presentation (1% vs 37%), and disease burden (c T4N1-3 2% vs 35%; cT4N0 1% vs 21%; cT3N1-3 3% vs 33%). Among neo cases, pCR rate was 48% (52% in HR-, 43% in HR+). For adj cases, p stage was T4N1-3 in 3%; T3N1-3 in 20%, and T0-2N2-3 in 77%. The table belowshows 5 y RFS and BCSS estimates. Conclusions: HR- BC had 15% lower 5 y RFS than HR+ disease. Neo cases had higher disease burden, explaining thier worse RFS and BCSS. Higher pCR rate in HR- disease, and better RFS and BCSS for pCR vs non-pCR is consistent with neo trials. Allowing for differences in follow up, stage, and HR status, our results for neo CT/T are similar to those in the NOAH study. They confirm the need to improve therapy in LA HER2+ BC, especially HR- and non-pCR cases. Neo pertuzumab and post-neo TDM-1 may in part address this need. 5-year RFS, BCSS. n (%) 5y RFS %, (95% CI) p-value 5y BCSS%, (95% CI) p-value All 380 75 (71, 80) - 81 (76, 84) - HR+ 230 (61) 82 (76, 86) - 88 (83, 92) - HR- 143 (38) 67 (58, 74) - 70 (61, 76) - Adj 258 (68) 80 (74, 84) 0.002 85 (80, 89) 0.004 Neo 122 (32) 66 (57, 74) 71 (62, 79) pCR yes (26 HR+, 32 HR-, 1 unk) 59 (48) 81 (68, 89) 0.002 85 (72, 92) 0.001 pCR no (34 HR+, 29 HR-) 63 (52) 53 (39, 64) 59 (45, 70)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".