Outcomes of non-metastatic HER-2 positive breast cancer before and after the introduction of anti-HER-2 therapy: a retrospective study from a tertiary Egyptian center.

Aya Alaaeldin Youssef Ibrahim, Amal Mostafa Ismail, Mona Mohamed Fouda, Khaled Mahmoud Abouelkhair

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Article in Journal of the Egyptian National Cancer Institute, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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Aya Alaaeldin Youssef IbrahimDepartment of Clinical Oncology and Nuclear Medicine, Mansoura University Hospital, Mansoura, Egypt. dr.ayaalaaeldin@gmail.com.

Amal Mostafa IsmailDepartment of Clinical Oncology and Nuclear Medicine, Mansoura University Hospital, Mansoura, Egypt.

Mona Mohamed FoudaDepartment of Clinical Oncology and Nuclear Medicine, Mansoura University Hospital, Mansoura, Egypt.

Khaled Mahmoud AbouelkhairDepartment of Clinical Oncology and Nuclear Medicine, Mansoura University Hospital, Mansoura, Egypt.

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Abstract

backgroundHER-2 positive breast cancer accounts for 15-20% of cases and is associated with aggressive behavior and poor prognosis. Anti-HER-2 therapy, including trastuzumab and pertuzumab, has improved outcomes in Western populations; however, real-world data in Egyptian patients remain limited. This study evaluated pathological response, disease-free survival (DFS), and overall survival (OS) among Egyptian patients with non-metastatic HER-2 positive breast cancer treated before and after the introduction of anti-HER-2 therapy.

methodsWe retrospectively analyzed 200 female patients with non-metastatic HER-2 positive breast cancer treated in two treatment eras: before the introduction of anti-HER-2 therapy (2014-2016, n = 100) and after its introduction (2020-2022, n = 100). Patients in the later era received trastuzumab alone or trastuzumab plus pertuzumab in the neoadjuvant or adjuvant setting. Outcomes included pathological complete response (pCR), DFS, OS. Survival outcomes were assessed using Kaplan-Meier analysis and compared using the log-rank test. Univariable and multivariable Cox proportional hazards regression analyses were performed for DFS and OS.

resultsAnti-HER-2 therapy was associated with a higher pCR rate among patients who received neoadjuvant treatment (40.0% vs. 10.3%, p < 0.001) and more favorable postoperative tumor and nodal staging. The median follow-up duration was 51.2 months in the non-anti-HER-2 group and 40.0 months in the anti-HER-2 group. During follow-up, disease recurrence occurred in 60% of patients in the non-anti-HER-2 group compared with 17% in the anti-HER-2 group (p < 0.001), while overall mortality was 13% in the anti-HER-2 group compared with 59% in the non-anti-HER-2 group (p < 0.001). Multivariable Cox regression analysis showed that anti-HER-2 therapy was associated with improved DFS (HR 0.274, 95% CI 0.108-0.697; P = 0.007) and OS (HR 0.260, 95% CI 0.093-0.728; P = 0.010).

conclusionIn this retrospective study of Egyptian patients with non-metastatic HER-2 positive breast cancer, treatment in the later era, when anti-HER-2 therapy was available, was associated with higher pathological response rates and improved DFS and OS. However, given the historical-cohort design and differences in baseline characteristics and treatment strategies between the two eras, these findings cannot establish a causal effect of anti-HER-2 therapy alone. Larger multicenter studies are warranted to further evaluate outcomes and address treatment-era and selection-related confounding in the Egyptian setting.

Indexed as

Antineoplastic Combined Chemotherapy ProtocolsBreast NeoplasmsErb-b2 Receptor Tyrosine KinasesAdultAgedAntibodies, Monoclonal, HumanizedDisease-Free SurvivalEgyptFemaleHumansMiddle AgedNeoadjuvant TherapyPathologic Complete ResponsePrognosisRetrospective StudiesTertiary Care CentersAntibodies, Monoclonal, HumanizedERBB2 protein, humanErb-b2 Receptor Tyrosine KinasespertuzumabTrastuzumabAnti-HER-2 therapyBreast cancerDisease-free survivalHER-2 positiveOverall survivalPathological complete response

Identifiers

PMID42911354

DOI10.1186/s43046-026-00420-4

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