NEW YORK (Reuters Health) – Breast reconstruction after cancer surgery doesn’t need to be delayed if the patient is taking trastuzumab, new research suggests.
“Our study shows that breast reconstruction need not be delayed among women receiving HER-2 targeted therapy with trastuzumab alone,” senior author Dr. Scott T. Hollenbeck of Duke University Medical Center in Durham, North Carolina, told Reuters Health by email.
“Our finding that combination trastuzumab plus pertuzumab targeted HER-2 therapy increases a patient’s risk for postoperative complications is surprising in that no prior studies have examined this association. Conversely, the finding that trastuzumab monotherapy is not associated with an increased risk of postoperative complications is equally important and surprising, because many patients will undergo breast reconstruction within 6 weeks of having completed trastuzumab monotherapy,” he said.
“Dual HER-2 inhibition with trastuzumab and pertuzumab was associated with increased postoperative wound complications, and we will investigate this further in a larger study cohort,” he added.
For the present study, Dr. Hollenbeck and colleagues retrospectively analyzed data from 481 women who had received chemotherapy and post-mastectomy reconstruction at one academic medical center from 2006 to 2016. About a quarter received targeted HER-2 therapy (with trastuzumab plus pertuzumab or with trastuzumab alone) within 6 weeks before initiating breast reconstruction; the rest received no targeted HER-2 therapy.
Within this cohort, the researchers matched 107 pairs of women (one who did and one who did get targeted HER-2 therapy) by age, diabetes status, obesity, tobacco use, neoadjuvant chemotherapy, chemotherapy regimen, and radiation therapy. After breast reconstruction, the women were followed for a median of 26.5 months.
As reported online October 3 in Journal of the American College of Surgeons, patients receiving combined trastuzumab and pertuzumab therapy before breast reconstruction had significantly higher risk of postoperative wound breakdown that required surgical closure, compared with patients not undergoing targeted HER-2 therapy (odds ratio, 65.29). However, HER-2 therapy with trastuzumab alone was not significantly associated with reconstructive complications.
Tumor size of 2 cm to 5 cm was associated with significantly lower risk of postoperative wound breakdown (OR, 0.41), compared with tumor size <2 cm.
“Currently there is no clinical evidence to guide the timing of post-mastectomy breast reconstruction among women who receive HER-2 targeted therapy in addition to chemotherapy,” Dr. Hollenbeck noted. “These targeted therapy regimens typically overlap with breast reconstructive surgery.”
“These study results may help guide breast surgeons and plastic surgeons in counseling their patients about the optimal time for undergoing breast reconstruction. These initial results suggest that a patient’s reconstruction does not need to be delayed in order to complete trastuzumab therapy,” Dr. Hollenbeck said. “However, in those patients who have recently received a regimen of pertuzumab plus trastuzumab, the potential need to delay breast reconstruction may be warranted.”
“The potential biological mechanism behind why the synergistic effect of trastuzumab plus pertuzumab may delay wound healing remains unanswered and is a topic that needs to be further explored,” he advised.
Dr. Hollenbeck and his group plan to conduct a prospective study of patients receiving targeted HER-2 therapy and having breast reconstruction, and he would like to see future prospective and multi-institutional studies explore the safety of combination targeted HER-2 therapy in breast reconstructive surgery.
SOURCE: http://bit.ly/2gzGcmo
J Am Coll Surg 2017.
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