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Improved Survival of HER2+ Breast Cancer Patients Treated with Trastuzumab and Chemotherapy Is Associated with Host Antibody Immunity against the HER2 Intracellular Domain. | LitMetric

AI Article Synopsis

  • The study found that adding trastuzumab to chemotherapy improves survival rates for patients with HER2(+) breast cancer by enhancing immune responses not just targeted at HER2, but also to other related proteins.
  • Analysis of blood samples from 48 women revealed that many had elevated antibodies to specific cancer-related proteins before treatment, and after receiving trastuzumab and chemotherapy, a significant majority (69%) showed increased antibody responses, which correlated with better progression-free survival (PFS) and overall survival (OS).
  • Interestingly, patients with high preexisting immunity to HER2-ICD did not benefit from the treatment, highlighting a complex relationship between the immune response and treatment efficacy.

Article Abstract

The addition of trastuzumab to chemotherapy extends survival among patients with HER2(+) breast cancer. Prior work showed that trastuzumab and chemotherapy augments HER2 extracellular domain (ECD)-specific antibodies. The current study investigated whether combination therapy induced immune responses beyond HER2-ECD and, importantly, whether those immune responses were associated with survival. Pretreatment and posttreatment sera were obtained from 48 women with metastatic HER2(+) breast cancer on NCCTG (now Alliance for Clinical Trials in Oncology) studies, N0337 and N983252. IgG to HER2 intracellular domain (ICD), HER2-ECD, p53, IGFBP2, CEA, and tetanus toxoid were examined. Sera from 25 age-matched controls and 26 surgically resected HER2(+) patients were also examined. Prior to therapy, some patients with metastatic disease had elevated antibodies to IGFBP2, p53, HER2-ICD, HER2-ECD, and CEA, but not to tetanus toxin, relative to controls and surgically resected patients. Treatment augmented antibody responses to HER2-ICD in 69% of metastatic patients, which was highly associated with improved progression-free survival (PFS; HR = 0.5, P = 0.0042) and overall survival (OS; HR = 0.7, P = 0.038). Augmented antibody responses to HER2-ICD also correlated (P = 0.03) with increased antibody responses to CEA, IGFBP2, and p53, indicating that treatment induces epitope spreading. Paradoxically, patients who already had high preexisting immunity to HER2-ICD did not respond to therapy with increased antibodies to HER2-ICD and demonstrated poorer PFS (HR = 1.6, P < 0.0001) and OS (HR = 1.4, P = 0.0006). Overall, the findings further demonstrate the importance of the adaptive immune system in the efficacy of trastuzumab-containing regimens. Cancer Res; 76(13); 3702-10. ©2016 AACR.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5594563PMC
http://dx.doi.org/10.1158/0008-5472.CAN-15-3091DOI Listing

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