npj Breast Cancer (Jul 2022)

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

  • Elisa Agostinetto,
  • Lieveke Ameye,
  • Samuel Martel,
  • Philippe Aftimos,
  • Noam Pondé,
  • Christian Maurer,
  • Sarra El-Abed,
  • Yingbo Wang,
  • Malou Vicente,
  • Saranya Chumsri,
  • Judith Bliss,
  • Judith Kroep,
  • Marco Colleoni,
  • Fausto Petrelli,
  • Lucia Del Mastro,
  • Alvaro Moreno-Aspitia,
  • Martine Piccart,
  • Marianne Paesmans,
  • Evandro de Azambuja,
  • Matteo Lambertini

DOI
https://doi.org/10.1038/s41523-022-00452-8
Journal volume & issue
Vol. 8, no. 1
pp. 1 – 8

Abstract

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Abstract 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.