# Predictive factors for outcome in HER2-low breast cancer patients after neoadjuvant chemotherapy

## TL;DR

This study identifies factors that predict survival outcomes for HER2-low breast cancer patients who do not achieve a complete response to chemotherapy.

## Contribution

The study identifies the Miller/Payne grading system and hormone receptor status as novel predictors of survival in HER2-low breast cancer patients.

## Key findings

- Patients achieving pCR after NAC had better disease-free survival compared to those who did not.
- The Miller/Payne grading system was a significant predictor of both disease-free and overall survival.
- Hormone receptor status was an independent predictor of disease-free survival in non-pCR patients.

## Abstract

The present study aimed to evaluate the predictive factors that predict outcomes of HER2-low breast cancer patients who did not achieve pathological complete response(pCR) after neoadjuvant chemotherapy (NAC).

This study included patients with HER2-low breast cancer who received NAC from January 2017 to December 2020. Analysis of the clinicopathological features, NAC response and outcome of the patients were retrospectively analyzed. Univariate and multivariable Cox analysis were used to determine factors that predict outcomes of HER2-low breast cancer patients who did not exhibit pCR.

293 Asian patients were included. The proportion of patients with hormone receptor (HR) positive and triple negative breast cancer (TNBC) among HER2-low patients was 75.8% and 24.2%, respectively. The pCR rate of HR positive cases was significantly lower than TNBC (27.5% vs. 53.5%, P=0.000). The patients who obtained pCR after NAC showed better disease-free survival(DFS) (5-year DFS 93.9% vs. 83.1%, p=0.039). For patients not achieving pCR, multivariable analysis showed that Miller/Payne (MP) grading system (hazard ratio: 0.094; 95% CI: 0.037-0.238; p=0.000) and HR status (hazard ratio: 2.561; 95% CI: 1.100-5.966; p=0.029) were significant independent predictors for DFS. Additionally, The MP grading system was also an independent predictor of overall survival (OS) (hazard ratio: 0.071; 95% CI: 0.019-0.260; p=0.000).

The results of our study show that pathological assessment following NAC offers valuable insights into the survival outcome of HER2-low breast cancer. According to these findings, responses to NAC should be considered when choosing systemic treatment for patients with HER2-low breast cancer.