Cancer Research and Treatment

Original Articles

Breast cancer

Impact of High Lymph Node Burden on Brain Metastases in Patients Who Achieved Pathological Complete Response after Neoadjuvant Chemotherapy in HER2-Positive Breast Cancer: Seung Ah Lee, Ki Jo Kim, Do Youn Woen, Su Min Lee, Kawon Oh, Cho Eun Lee, Woong Ki Park, Ji Won Yoo, Dong Seung Shin, Jai Min Ryu, Se Kyung Lee, Byung Joo Chae, Jonghan Yu, Seok Won Kim, Seok Jin Nam, Ji-Yeon Kim, Yeon Hee Park, Eun Young Ko, Eun Sook Ko, Jeong Eon Lee; Cancer Res Treat. 2026;58(3):780-789. Published online July 8, 2025; DOI: https://doi.org/10.4143/crt.2025.219

Abstract PDF Supplementary Material PubReader ePub: Purpose
This study aims to investigate the clinical characteristics, outcomes, and predictors of brain metastases in human epidermal growth factor receptor 2 (HER2)–positive advanced breast cancer patients who achieved pathological complete response (pCR) following neoadjuvant chemotherapy (NAC). This research seeks to inform surveillance strategies and optimize management for high-risk subgroups.
Materials and Methods
A retrospective analysis of 1,757 patients (2008-2022) classified them into pCR (n=914) and non-pCR (n=843) groups post-NAC. Collected data included demographics, clinical features, and metastasis parameters. Survival outcomes and brain metastasis predictors were assessed using Kaplan-Meier curves, Cox models, and logistic regression.
Results
Among pCR patients, brain metastases accounted for 54.2% of distant metastases, significantly affecting overall survival (p < 0.001). Median distant metastasis-free survival was shorter for brain metastases (13.4 months) compared to extracranial metastases (31.1 months) in the pCR group (p=0.005). Positive supraclavicular node (SCN) fine needle aspiration (FNA) and clinical N3 (cN3) category were the strongest predictors of brain metastases (SCN FNA: odds ratio [OR], 12.9; p < 0.001; cN3: OR, 12.1; p < 0.001). Multivariable Cox regression analysis revealed that positive SCN FNA and cN3 category were strong predictors of reduced distant metastasis-free survival (SCN FNA: hazard ratio, 2.5; 95% confidence interval [CI], 1.3 to 3.6; p < 0.001; cN3: hazard ratio, 11.3; 95% CI, 4.9 to 33.0; p < 0.001).
Conclusion
This study highlights the challenges of brain metastases in HER2-positive pCR patients, emphasizing the need for tailored therapeutic strategies and enhanced surveillance. High lymph node burden prior to NAC is a significant factor in risk assessment. Therefore, it may be advisable to recommend post-surgery surveillance for high-risk patients.

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Real World Evidence of Neoadjuvant Docetaxel/Carboplatin/Trastuzumab/Pertuzumab (TCHP) in Patients with HER2-Positive Early or Locally Advanced Breast Cancer: A Single-Institutional Clinical Experience: Ji-Yeon Kim, Seok Jin Nam, Jeong Eon Lee, Jonghan Yu, Byung Joo Chae, Se Kyung Lee, Jai Min Ryu, Jin Seok Ahn, Young-Hyuck Im, Seok Won Kim, Yeon Hee Park; Cancer Res Treat. 2022;54(4):1091-1098. Published online January 10, 2022; DOI: https://doi.org/10.4143/crt.2021.901

Abstract PDF Supplementary Material PubReader ePub

Purpose
Docetaxel/carboplatin/trastuzumab/pertuzumab (TCHP) regimen is frequently used to treat early and locally advanced human epidermal growth factor receptor 2 (HER2)–positive breast cancer (BC) in neoadjuvant setting. However, large-scaled real-world evidence did not exist.
Materials and Methods
We retrospectively reviewed medical records of patients with early or locally advanced HER2-positive BC who underwent neoadjuvant TCHP followed by curative surgery at Samsung Medical Center between January 2016 and August 2020.
Results
Of 447 patients, 316 (70.7%) received breast-conserving surgery and 131 (29.3%) received total mastectomy. In terms of neoadjuvant chemotherapy response, pathologic complete response (pCR) and residual cancer burden (RCB) score were analyzed. The rate of pCR was 64% a class of RCB 0 was observed in 65% of cases, RCB class I in 12%, RCB class II in 14%, and RCB class III in 2%. The 3-year event-free survival rate was 90.6%, BC with pCR occurred in 92.8%, and BC with non-pCR in 86.3% (p=0.016). In terms of distant metastasis, the 3-year distant recurrence-free survival rate was 93.5%; BC with pCR occurred in 95.9% and BC with non-pCR in 89.2% (p=0.013). Mucositis (85.2%), pain (83.2%), and diarrhea (70.5%) were the most common non-hematologic adverse events. In terms of hematologic adverse events, anemia (89.9%) was the most commonly observed adverse events followed by thrombocytopenia (29.8%).
Conclusion
Neoadjuvant TCHP therapy had a pCR rate of 64% and a 3-year event-free survival of 90% in real world experience. In terms of toxicity profile, anemia was frequently observed and adequate management including occasional transfusion was required.

Citations

Citations to this article as recorded by

Efficacy, safety, and biomarkers of neoadjuvant trastuzumab and pertuzumab combined with chemotherapy in Chinese patients with HER2-positive breast cancer: a multicenter retrospective cohort study
Xiaowei Qi, Hong Hu, Pengfei Qiu, Wenlin Chen, Xiaochun Wang, Qiyun Shi, Yan Xu, Shu Liu, Yanman Fang, Taolang Li, Jia Ming, Sihai Zhou, Fan Chai, Yueyang Liang, Yuanming Fan, Peng Tang, Li Chen, Shushu Wang, Jun Jiang, Mengyuan Wang, Yi Zhang, Jianyun Ni
International Journal of Surgery.2026; 112(1): 1318. CrossRef
Systemic Treatment for Patients with Early-Stage Breast Cancer
Hee Kyung Ahn
The Korean Journal of Medicine.2026; 101(2): 70. CrossRef
Bridging Clinical Trials to Real-World Clinical Practice: TCHP Neoadjuvant Therapy Outcomes in HER2-Positive Breast Cancer
Baha Sharaf, Alaa Seif, Hira Bani Hani, Maha Alhasan, Rnad Khader, Maram Al-Yag'oub, Ameed Ghanem, Jinan Bani Ata, Batool Ajlouni, Qutaiba Jawarneh, Adel Jaffal, Faris Tamimi, Sharif Jehad, Haneen Al-Abdallat, Osama Mahafdah, Hikmat Abdel-razeq
Breast Cancer: Targets and Therapy.2026; Volume 18: 1. CrossRef
Response-Adapted Surgery for Residual Calcifications in HER2-Positive Breast Cancer After Neoadjuvant Chemotherapy
Jeong Eon Lee, Cho Eun Lee, Seok Jin Nam, Seok Won Kim, Jonghan Yu, Byung Joo Chae, Se Kyung Lee, Jai Min Ryu, Eun Young Ko, Ji Soo Choi, Eun Sook Ko, Jeongmin Lee, Boo-Kyung Han, Woong Ki Park
Journal of Breast Cancer.2026; 29(3): 299. CrossRef
Tumors >2 cm in node-negative, HER2-positive breast cancer: comparing neoadjuvant dual-targeted versus adjuvant single-targeted treatment pathways in real-world practice
Xiaoduo Li, Kexuan Feng, Junjie Liu, Xiaoqian Li, Rui Zhang, Huimin Zhang
Therapeutic Advances in Medical Oncology.2026;[Epub] CrossRef
Neoadjuvant anthracycline-free versus anthracycline-containing chemotherapy combined with dual HER2 blockade in HER2-positive breast cancer: a real-world comparative study
Asli Buyukkuscu, Zehra Sucuoglu Isleyen, Omer Burak Ekinci, Tugay Atasever, Kubra Akkaya, Okan Aydin, Gamze Kulduk, Emir Celik, Kayhan Erturk, M. Mustafa Atci
Breast Cancer Research.2026;[Epub] CrossRef
Decrease in Calcifications After Neoadjuvant Treatment Predicts Invasive Tumor Response but Not Complete DCIS Eradication: Systematic Review and Meta-Analysis
Noam Weiner, Yaron Niv, Eran Sharon
Clinical Breast Cancer.2025; 25(7): e990. CrossRef
Comparison of T-DM1 and trastuzumab-pertuzumab in HER2-positive breast cancer patients with residual disease after neoadjuvant therapy: a retrospective study
Junxiao Wang, Yushuai Yu, Qisheng Lin, Xin Wang
World Journal of Surgical Oncology.2025;[Epub] CrossRef
Pertuzumab/Docetaxel/Carboplatin/Trastuzumab Regimen in Human Epidermal Growth Factor Receptor 2–Positive Early, Locally Advanced, and Oligometastatic Breast Cancer: Real-World Outcomes From India
Ajay Gogia, Atul Batra, Ashutosh Mishra, Kamal Kataria, Surendra K. Saini, Sandeep Mathur, Chandra P. Prasad, Hari Krishna Raju Sagiraju
JCO Global Oncology.2025;[Epub] CrossRef
De-escalation of neoadjuvant taxane and carboplatin therapy in HER2-positive breast cancer with dual HER2 blockade: a multicenter real-world experience in China
Song Wu, Li Bian, Haibo Wang, Shaohua Zhang, Tao Wang, Zhigang Yu, Jianbin Li, Feng Li, Kun Wang, Zefei Jiang
World Journal of Surgical Oncology.2024;[Epub] CrossRef
Distinct ER and PR expression patterns significantly affect the clinical outcomes of early HER2-positive breast cancer: A real-world analysis of 871 patients treated with neoadjuvant therapy
Haizhu Chen, Xiujuan Gui, Ziwei Zhou, Fengxi Su, Chang Gong, Shunrong Li, Wei Wu, Nanyan Rao, Qiang Liu, Herui Yao
The Breast.2024; 75: 103733. CrossRef
Impact of adding pertuzumab to trastuzumab plus chemotherapy in neoadjuvant treatment of HER2 positive breast cancer patients: a multicenter real-life HER2PATH study
Ahmet Bilici, Omer Fatih Olmez, Muhammed Ali Kaplan, Berna Oksuzoglu, Ahmet Sezer, Nuri Karadurmus, Erdem Cubukcu, Mehmet Ali Nahit Sendur, Sercan Aksoy, Dilek Erdem, Gul Basaran, Burcu Cakar, Abdallah T. M. Shbair, Cagatay Arslan, Ahmet Taner Sumbul, Sem
Acta Oncologica.2023; 62(4): 381. CrossRef
Pathologic Complete Response Achieved in Early-Stage HER2-Positive Breast Cancer After Neoadjuvant Therapy With Trastuzumab and Chemotherapy vs. Trastuzumab, Chemotherapy, and Pertuzumab: A Systematic Review and Meta-Analysis of Clinical Trials
Faizan Fazal, Muhammad Nauman Bashir, Maham Leeza Adil, Usama Tanveer, Mansoor Ahmed, Taha Zahid Chaudhry, Ali Ahmad Ijaz, Muhammad Haider
Cureus.2023;[Epub] CrossRef
Trends of axillary surgery in breast cancer patients with axillary lymph node metastasis: a comprehensive single-center retrospective study
Yeon Jin Kim, Hye Jin Kim, Soo Yeon Chung, Se Kyung Lee, Byung Joo Chae, Jonghan Yu, Jeong Eon Lee, Seok Won Kim, Seok Jin Nam, Jai Min Ryu
Annals of Surgical Treatment and Research.2023; 105(1): 10. CrossRef
Anthracyclines versus No Anthracyclines in the Neoadjuvant Strategy for HER2+ Breast Cancer: Real-World Evidence
Inês Soares de Pinho, Paulo Luz, Lucy Alves, Raquel Lopes-Brás, Vanessa Patel, Miguel Esperança-Martins, Lisa Gonçalves, Ritas Freitas, Diana Simão, Maria Roldán Galnares, Isabel Fernandes, Silvia Artacho Criado, Salvador Gamez Casado, Jose Baena Cañada,
Clinical Drug Investigation.2023; 43(9): 691. CrossRef
Benefit of postoperative regional nodal irradiation in patients receiving preoperative systemic therapy with docetaxel/carboplatin/trastuzumab/pertuzumab for HER2-positive breast cancer
Nalee Kim, Ji-Yeon Kim, Won Park, Won Kyung Cho, Tae Gyu Kim, Young-Hyuck Im, Jin Seok Ahn, Jeong Eon Lee, Seok Jin Nam, Seok Won Kim, Jonghan Yu, Byung Joo Chae, Sei Kyung Lee, Jai-Min Ryu, Yeon Hee Park, Haeyoung Kim
The Breast.2023; 72: 103594. CrossRef
Response Rate and Safety of a Neoadjuvant Pertuzumab, Atezolizumab, Docetaxel, and Trastuzumab Regimen for Patients With ERBB2-Positive Stage II/III Breast Cancer
Hee Kyung Ahn, Sung Hoon Sim, Koung Jin Suh, Min Hwan Kim, Jae Ho Jeong, Ji-Yeon Kim, Dae-Won Lee, Jin-Hee Ahn, Heejung Chae, Kyung-Hun Lee, Jee Hyun Kim, Keun Seok Lee, Joo Hyuk Sohn, Yoon-La Choi, Seock-Ah Im, Kyung Hae Jung, Yeon Hee Park
JAMA Oncology.2022; 8(9): 1271. CrossRef

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Validation of Korean Version of the COmprehensive Score for financial Toxicity (COST) Among Breast Cancer Survivors: Sungkeun Shim, Danbee Kang, Nayeon Kim, Gayeon Han, Jihyun Lim, Hyunsoo Kim, Jeonghyun Park, Mankyung Lee, Jeong Eon Lee, Seok Won Kim, Jonghan Yu, Byung Joo Chae, Jai Min Ryu, Seok Jin Nam, Se Kyung Lee, Juhee Cho; Cancer Res Treat. 2022;54(3):834-841. Published online October 13, 2021; DOI: https://doi.org/10.4143/crt.2021.784

Abstract PDF Supplementary Material PubReader ePub

Purpose
Little is known about the impact of financial toxicity in disease-free breast cancer survivors. We aim to validate the COmprehensive Score for financial Toxicity in Korean (COST-K) and evaluate financial toxicity among disease-free breast cancer survivors.
Materials and Methods
We conducted linguistic validation following a standardized methodology recommended by Functional Assessment of Chronic Illness Therapy multilingual translation (FACITtrans). For psychometric validation, we conducted a cross-sectional survey with 4,297 disease-free breast cancer survivors at a tertiary hospital in Seoul, Korea between November 2018 and April 2019. Survivors were asked to complete the COST-K and European Organization for Research and Treatment of Cancer Quality of Life Core 30 (EORTC QLQ-C30) questionnaires. The test-retest reliability, internal consistency, and validity of the COST-K were assessed using standard scale construction techniques.
Results
The COST-K demonstrated good internal consistency, with a Cronbach’s α of 0.81. The test-retest analysis revealed an intraclass correlation coefficient of 0.78. The COST-K had moderate correlation (r=–0.60) with the financial difficulty item of the EORTC QLQ-C30 and week correlation with the items on acute and chronic symptom burdens (nausea/vomiting, –0.18; constipation, –0.14; diarrhea, –0.14), showing good convergent and divergent validity. The median COST-K was 27 (range, 0 to 44; mean±standard deivation [SD], 27.1±7.5) and about 30% and 5% of cancer survivors experienced mild and severe financial toxicity, respectively. Younger age, lower education, lower household income was associated with higher financial toxicity.
Conclusion
The COST-K is a valid and reliable instrument for measuring financial toxicity in disease-free breast cancer survivors. Considering its impact on the health-related quality of life, more studies need to be conducted to evaluate financial toxicity in cancer survivors and design interventions.

Citations

Citations to this article as recorded by

Financial Hardship Among Newly Diagnosed Patients with Lung Cancer and Their Caregivers: A Dyadic Analysis
Shumin Jia, Yongchun Cui, Denise Shuk Ting Cheung, Pui Hing Chau, Chia-Chin Lin
Seminars in Oncology Nursing.2026; 42(1): 152119. CrossRef
Perceived financial toxicity after active treatment and its association with clinical outcomes among breast cancer survivors: A prospective cohort study
Doyoun Woen, Danbee Kang, Juwon Park, Hyunsoo Kim, Su Min Lee, Seok Jin Nam, Seok Won Kim, Jeong Eon Lee, Jong Han Yu, Byung Joo Chae, Jai Min Ryu, Woong Ki Park, Juhee Cho, Se Kyung Lee
The Breast.2026; 85: 104697. CrossRef
A systematic review of financial toxicity measurement instruments for cancer patients based on the COSMIN guideline
Mingfang Jia, Liyi Zhong, Yingxia Luo, Oudong Xia
Journal of Patient-Reported Outcomes.2026;[Epub] CrossRef
Financial Toxicity in Cervical Cancer Patients Undergoing Radical Treatment With External Beam Radiation and Brachytherapy at a Tertiary New Zealand Radiation Oncology Centre
G. Franklin, P. Larsen, C. Henry, C. Johnson
Journal of Medical Imaging and Radiation Oncology.2026;[Epub] CrossRef
Factors Associated With Financial Toxicity Among Family Caregivers of People Living With Dementia in South Korea: A Cross-Sectional Survey
Suyeon Noh, Hyun Ju Seo, Jeong Lan Kim, Seong Min Kim, Jeong Min Park, Yumi Choi, Hyejeong Yang, Hana Choi
Research in Gerontological Nursing.2026; : 1. CrossRef
Prevalence and Determinants of Financial Toxicity Among Patients with Breast Cancer: A Systematic Review and Meta-Analysis
Mohammad Akbari, Maryam Seyed-Nezhad, Hassan Karami, Maryam Shirvani-Shiri, Mohammad Moradi-Joo
International Journal of Cancer Management.2026;[Epub] CrossRef
Financial Toxicity Among Breast Cancer Patients
Yi Kuang, Xiaoyi Yuan, Zheng Zhu, Weijie Xing
Cancer Nursing.2025; 48(3): e166. CrossRef
Associations between financial toxicity, health-related quality of life, and well-being in Indonesian patients with breast cancer
Stevanus Pangestu, Fredrick Dermawan Purba, Hari Setyowibowo, Clara Mukuria, Fanni Rencz
Quality of Life Research.2025; 34(6): 1709. CrossRef
Trajectories and predictors of financial toxicity in breast cancer patients: A multicenter longitudinal study in China
Yi Kuang, Jiajia Qiu, Ye Liu, Sijin Guo, Ting Chen, Lichen Tang, Winnie K.W. So, Weijie Xing
The Breast.2025; 81: 104441. CrossRef
Cross‐Cultural Validation of the COmprehensive Score for Financial Toxicity (COST) Measure in an Australian Sample
Bora Kim, Claudia Rutherford, Lucy Lehane, Judith Fethney, Louise Acret, Tracy King, Patsy Kenny, Richard De Abreu Lourenco, Kate White
Cancer Medicine.2025;[Epub] CrossRef
Factors associated with unmet supportive care needs among adult cancer survivors in South Korea: a cross-sectional survey
Dal-Lae Jin, Young Ae Kim, Su Jung Lee, Hyun-Ju Seo, Seok-Jun Yoon
Journal of Cancer Survivorship.2025;[Epub] CrossRef
Unraveling the vicious cycle: longitudinal analysis between financial toxicity and symptom burden in women with breast cancer
Yi Kuang, Xiang Qi, Jiajia Qiu, Ye Liu, Sijin Guo, Ting Chen, Lichen Tang, Winnie K. W. So, Weijie Xing
Supportive Care in Cancer.2025;[Epub] CrossRef
Associations of Financial Toxicity with Employment Concerns and Cancer-Related Distress: A Cross-Sectional Survey among Korean Working-Age Cancer Survivors
Hyun-Ju Seo, Dal-Lae Jin, Young Ae Kim, Su Jung Lee, Seok-Jun Yoon
Cancer Research and Treatment.2025; 57(3): 659. CrossRef
Breast Cancer Information Grand Round for Survivorship (BIG-S) prospective cohort
Danbee Kang, Juwon Park, Hyunsoo Kim, Jeong Eon Lee, Seok Jin Nam, Seok Won Kim, Jonghan Yu, Byung Joo Chae, Jai Min Ryu, Juhee Cho, Se Kyung Lee
European Journal of Epidemiology.2025; 40(8): 959. CrossRef
Financial toxicity on treatment outcomes in head & neck cancer patients undergoing radiation therapy
Garrett K. Harada, Eric Ku, Jino Park, Akul Munjal, Nicholas Peterson, Sophie Hsu, Rupali Banker, Shirin Attarian, Erin Healy, Michael Hoyt, Gelareh Sadigh, Allen Chen, Jeremy P. Harris
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Jeremy P. Harris, Eric Ku, Garrett Harada, Sophie Hsu, Elaine Chiao, Pranathi Rao, Erin Healy, Misako Nagasaka, Jessica Humphreys, Michael A. Hoyt
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Victoria S. Wu, Xinglei Shen, Janet de Moor, Fumiko Chino, Jonathan Klein
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Supportive Care in Cancer.2024;[Epub] CrossRef
Validation of the COmprehensive Score for Financial Toxicity (COST) in Vietnamese patients with cancer
Binh Thang Tran, Dinh Duong Le, Thanh Gia Nguyen, Minh Tu Nguyen, Minh Hanh Nguyen, Cao Khoa Dang, Dinh Trung Tran, Le An Pham
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Stevanus Pangestu, Fanni Rencz
Value in Health.2023; 26(2): 300. CrossRef
Association between financial toxicity and health-related quality of life of patients with gynecologic cancer
Yusuke Kajimoto, Kazunori Honda, Shiro Suzuki, Masahiko Mori, Hirofumi Tsubouchi, Kohshiro Nakao, Anri Azuma, Takashi Shibutani, Shoji Nagao, Takahiro Koyanagi, Izumi Kohara, Shuko Tamaki, Midori Yabuki, Lida Teng, Keiichi Fujiwara, Ataru Igarashi
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Veni V. Sakti, Mahmoud Danaee, Cheng-Har Yip, Ros S. A. Bustamam, Marniza Saad, Gin Gin Gan, Jerome Tan, Yueh Ni Lim, Flora L.T. Chong, Murallitharan Munisamy, Farahida Mohd Farid, Boon Lui Sew, Yek-Ching Kong, Nishalini Muniandy, Nirmala Bhoo-Pathy
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Supportive Care in Cancer.2023;[Epub] CrossRef
Validity of the COmprehensive Score for financial Toxicity (COST) in patients with gynecologic cancer
Yusuke Kajimoto, Takashi Shibutani, Shoji Nagao, Satoshi Yamaguchi, Shiro Suzuki, Masahiko Mori, Hirofumi Tsubouchi, Kohshiro Nakao, Anri Azuma, Takahiro Koyanagi, Izumi Kohara, Shuko Tamaki, Midori Yabuki, Lida Teng, Kazunori Honda, Ataru Igarashi
International Journal of Gynecologic Cancer.2022; : ijgc-2022-003410. CrossRef

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