Background: The combination of pertuzumab and trastuzumab dual HER2 blockade with concomitant curative dose locoregional breast radiotherapy in patients with metastatic breast cancer is an important part of treatment strategy. Methods: This was a retrospective study conducted at the Institut Curie on all patients treated concomitantly with pertuzumab/trastuzumab and locoregional breast radiotherapy. Toxicity was evaluated according to the NCICTCAEv4.0. Overall survival, progression-free survival and locoregional recurrence-free survival were evaluated in metastatic patients who were initially well controlled by chemotherapy, for whom local treatment was decided by the multidisciplinary team. Results: Fifty-five patients treated between October 2013 and December 2019 were included, with a median follow-up of 4.1 years. The median age was 53 years (range: 28–81). All patients received curative dose radiotherapy (RT) concomitantly with pertuzumab and trastuzumab (Pertu/Trastu). The median radiation dose was 50 Gy. Safety evaluation did not reveal any significant adverse effects, with 3 cases of grade 3 radiodermatitis (5.4%), but no significant gastrointestinal or cardiac toxicity. The mean difference in LVEF before any chemotherapy and after radiotherapy was −2.43% (p < 0.01). Conclusions: This study demonstrates that the combination of locoregional breast RT with dual HER2 blockade by Pertu/Trastu was very well tolerated, suggesting that RT can be safely administered to patients with HER2-positive breast cancer.

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Data from primary BCs and recurrences were compared. The level of adherence to MS was assessed by a selection of the quality indicators (QIs) that are adopted by European Society of Breast Cancer Specialists (EUSOMA).Results: We included 263 patients treated for local recurrence of BC between January 2012 and March 2020. Median age at the time of first diagnosis was 45,2 years old. The time interval between the primary tumour (PT) and recurrence was between 1 month to 36 years. Most PTs were in T1 stage -68.8% (T1a -1,5%, T1b e 49%, T1c e 18,3%), and only 0.8% of them were T3. The lymph nodes status was N0 in 52% of patients. Regional lymph nodes could not be assessed (Nx) in 11,4% of patients, leading to decrease levels of adherence to MS. 67,3% of relapsing patients had high oestrogen receptor (ER+) titres (!50%). We reported HER2 À in 79,8% of patients with PT and in 85,2% of relapsing patients. ER+/PR+ and HER2À patients have higher risk of recurrence after 5 years, especially in patients with high ER titre. We assessed the level of adherence to MS using main QIs: 4a, 10a, 10b, 10c, 11a, 11c, 12, 13a and 13b. The results showed significant differences in the level of adherence to MS according to the patients' age, biological characteristics and clinical treatment.Conclusions: Despite many efforts that are being made to improve the quality of BC care, it would be greatly improved if we could reduce recurrences. Knowledge of the characteristics, prognostic factors and the monitoring of level of adherence to MS for BC recurrence can aid in the development of treatment strategies and follow-up in these patients at risk of recurrence.Legal entity responsible for the study: V. Mitova.

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