Pathological complete response, long-term outcomes, and recurrence patterns in HER2-low versus HER2-zero breast cancer after neoadjuvant chemotherapy

Background: The interest in HER2-low breast cancer (BC) has increased in recent years with the development of novel anti-HER2 antibody-drug conjugates. Here, we investi-gated the clinical outcomes and relapse patterns of patients with HER2-low or-zero BCs in an Asian population.Methods: We retrospectively identified HER2-low or-zero BC patients with stage I-III tu-mours who were treated with neoadjuvant chemotherapy and underwent curative surgery, be-tween 2014 and 2018 at Asan Medical Center, Seoul, Korea.Results: A total of 818 and 754 HER2-zero and HER2-low BC patients, respectively, were consecutively included in this analysis. The HER2-low group had more hormone receptor [HR]-positive patients (81% versus 56%, P < 0.001). The HER2-zero group had a higher pro-portion of patients who achieved pathological complete response (pCR) (14.7% versus 9.8%, P Z 0.003); however, no significant differences of pCR rate by HER2 status were identified inthe HR-positive (P = 0.4) and HR-negative groups (P = 0.3) when analysed separately. The HER2-low BC cases had higher 5-year overall survival (OS) and disease-free survival (DFS) rates (P < 0.001 for OS; P = 0.002 for DFS); however, no differences were observed in terms of OS and DFS by HER2 status in the HR-positive group (P = 0.21 for OS and P = 0.66 for DFS).Conclusions: Our current findings do not support that HER2-low BC had different biology and clinical features compared to HER2-zero BC in patients who treated with neoadjuvant chemotherapy. However, the prognostic impact of HER2-low status in BC remains controver-sial; thus warranting further research. 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).