{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:38:49Z","timestamp":1792669129710,"version":"4.5.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Egypt Natl Canc Inst"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>HER-2 positive breast cancer accounts for 15\u201320% 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We 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\u20132016,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009100) and after its introduction (2020\u20132022,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009100). 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\u2013Meier analysis and compared using the log-rank test. Univariable and multivariable Cox proportional hazards regression analyses were performed for DFS and OS.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Anti-HER-2 therapy was associated with a higher pCR rate among patients who received neoadjuvant treatment (40.0% vs. 10.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) 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 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), while overall mortality was 13% in the anti-HER-2 group compared with 59% in the non-anti-HER-2 group (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Multivariable Cox regression analysis showed that anti-HER-2 therapy was associated with improved DFS (HR 0.274, 95% CI 0.108\u20130.697;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.007) and OS (HR 0.260, 95% CI 0.093\u20130.728;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.010).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s43046-026-00420-4","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T10:44:09Z","timestamp":1792665849000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1186","volume":"38","author":[{"given":"Aya Alaaeldin Youssef","family":"Ibrahim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amal Mostafa","family":"Ismail","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mona Mohamed","family":"Fouda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled Mahmoud","family":"Abouelkhair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,22]]},"reference":[{"key":"420_CR1","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.breast.2022.08.010","volume":"66","author":"M Arnold","year":"2022","unstructured":"Arnold M, et al. Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast. 2022;66:15\u201323.","journal-title":"Breast"},{"key":"420_CR2","doi-asserted-by":"publisher","unstructured":"Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209\u201349. https:\/\/doi.org\/10.3322\/caac.21660.\u00a0Epub 2021 Feb 4. PMID: 33538338.","DOI":"10.3322\/caac.21660"},{"key":"420_CR3","doi-asserted-by":"publisher","first-page":"437971","DOI":"10.1155\/2014\/437971","volume":"2014","author":"AS Ibrahim","year":"2014","unstructured":"Ibrahim AS, et al. Cancer incidence in egypt: results of the national population-based cancer registry program. J Cancer Epidemiol. 2014;2014:437971.","journal-title":"J Cancer Epidemiol"},{"key":"420_CR4","doi-asserted-by":"publisher","first-page":"e2200387","DOI":"10.1200\/GO.22.00387","volume":"9","author":"HA Azim","year":"2023","unstructured":"Azim HA, et al. Clinicopathologic Features of Breast Cancer in Egypt-Contemporary Profile and Future Needs: A Systematic Review and Meta-Analysis. JCO Glob Oncol. 2023;9:e2200387.","journal-title":"JCO Glob Oncol"},{"issue":"2","key":"420_CR5","doi-asserted-by":"publisher","first-page":"119","DOI":"10.4103\/2230-8229.134771","volume":"21","author":"HM Mamdouh","year":"2014","unstructured":"Mamdouh HM, et al. Barriers to breast cancer screening among a sample of Egyptian females. J Family Community Med. 2014;21(2):119\u201324.","journal-title":"J Family Community Med"},{"issue":"6","key":"420_CR6","first-page":"1623","volume":"18","author":"E Esmail Hassan","year":"2017","unstructured":"Esmail Hassan E, Seedhom AE, Mahfouz EM. 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World J Clin Oncol. 2014;5(3):412\u201324.","journal-title":"World J Clin Oncol"},{"key":"420_CR9","first-page":"59","volume":"19","author":"B Sharaf","year":"2025","unstructured":"Sharaf B, et al. Dual Anti-HER2 Therapy Vs Trastuzumab Alone with Neoadjuvant Anthracycline and Taxane in HER2-Positive Early-Stage Breast Cancer: Real-World Insights. Biologics. 2025;19:59\u201371.","journal-title":"Biologics"},{"issue":"11","key":"420_CR10","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1056\/NEJM200103153441101","volume":"344","author":"DJ Slamon","year":"2001","unstructured":"Slamon DJ, et al. Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med. 2001;344(11):783\u201392.","journal-title":"N Engl J Med"},{"issue":"2","key":"420_CR11","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1056\/NEJMoa1113216","volume":"366","author":"J Baselga","year":"2012","unstructured":"Baselga J, et al. 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N Engl J Med. 2005;353(16):1673\u201384.","journal-title":"N Engl J Med"},{"issue":"33","key":"420_CR14","doi-asserted-by":"publisher","first-page":"3744","DOI":"10.1200\/JCO.2014.55.5730","volume":"32","author":"EA Perez","year":"2014","unstructured":"Perez EA, et al. Trastuzumab plus adjuvant chemotherapy for human epidermal growth factor receptor 2-positive breast cancer: planned joint analysis of overall survival from NSABP B-31 and NCCTG N9831. J Clin Oncol. 2014;32(33):3744\u201352.","journal-title":"J Clin Oncol"},{"issue":"9938","key":"420_CR15","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/S0140-6736(13)62422-8","volume":"384","author":"P Cortazar","year":"2014","unstructured":"Cortazar P, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. 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Due to the retrospective nature of the study, the requirement for informed consent was waived by the Institutional Review Board. The study was conducted in accordance with the principles of the Declaration of Helsinki and applicable institutional and local regulations.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"81"}}