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PREDICT underestimates survival of patients with HER2-positive early-stage breast cancer

par Agostinetto, Elisa;Ameye, Lieveke;Martel, Samuel;Aftimos, Philippe ;Pondé, Noam;Maurer, Christian;El-abed, Sarra;Wang, Yingbo;Vicente, Malou;Chumsri, Saranya;Bliss, Judith M;Kroep, Judith;Colleoni, Marco Angelo;Petrelli, Fausto;Del Mastro, Lucia;Moreno-Aspitia, Alvaro;Piccart-Gebhart, Martine ;Paesmans, Marianne ;de Azambuja, Evandro ;Lambertini, Matteo
Référence NPJ breast cancer, 8, 1, 87
Publication Publié, 2022-12

Article révisé par les pairs

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Résumé :

The prognostic performance of PREDICT in patients with HER2-positive early breast cancer (EBC) treated in the modern era with effective chemotherapy and anti-HER2 targeted therapies is unclear. Therefore, we investigated its prognostic performance using data extracted from ALTTO, a phase III trial evaluating adjuvant lapatinib ± trastuzumab vs. trastuzumab alone in patients with HER2-positive EBC. Our analysis included 2794 patients. After a median follow-up of 6.0 years (IQR, 5.8–6.7), 182 deaths were observed. Overall, PREDICT underestimated 5-year OS by 6.7% (95% CI, 5.8–7.6): observed 5-year OS was 94.7% vs. predicted 88.0%. The underestimation was consistent across all subgroups, including those according to the type of anti HER2-therapy. The highest absolute differences were observed for patients with hormone receptor negative-disease, nodal involvement, and large tumor size (13.0%, 15.8%, and 15.3%, respectively). AUC under the ROC curve was 73.7% (95% CI 69.7–77.8) in the overall population, ranging between 61.7% and 77.7% across the analyzed subgroups. In conclusion, our analysis showed that PREDICT highly underestimated OS in HER2-positive EBC. Hence, it should be used with caution to give prognostic estimation to HER2-positive EBC patients treated in the modern era with effective chemotherapy and anti-HER2 targeted therapies.