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Clin Breast Cancer. 2015 Feb;15(1):24-30. doi: 10.1016/j.clbc.2014.07.010. Epub 2014 Aug 15.

Long-term follow-up after preoperative trastuzumab and chemotherapy for HER2-overexpressing breast cancer.

Author information

1
Dana-Farber Cancer Institute, Boston, MA. Electronic address: emayer@partners.org.
2
Brigham and Women's Hospital, Boston, MA.
3
Case Comprehensive Cancer Center, Cleveland, OH.
4
Mt Kisco Medical Group, Mt Kisco, NY.
5
Dana-Farber Cancer Institute, Boston, MA.
6
Massachusetts General Hospital, Boston, MA.
7
Beth Israel Deaconess Medical Center, Boston, MA.

Abstract

BACKGROUND:

Neoadjuvant chemotherapy and trastuzumab is an established treatment for locally advanced HER2-positive breast cancer, providing favorable rates of clinical response and pCR. Minimal data describe long-term outcomes after neoadjuvant HER2-directed therapy. This study aimed to explore long-term efficacy and toxicity after neoadjuvant trastuzumab and chemotherapy for HER2-positive breast cancer.

PATIENTS AND METHODS:

Eligible patients participated in 1 of 2 single-arm phase II neoadjuvant trials, receiving either paclitaxel/trastuzumab (TH) or vinorelbine/trastuzumab (NH) for stage II-III HER2-positive disease. Postoperative chemotherapy, with or without trastuzumab, was offered. Charts were reviewed to identify recurrence, death, and treatment-related toxicities. Association of long-term outcomes with baseline characteristics and pathological response to primary therapy was explored.

RESULTS:

Eighty patients were identified; 33 (41.3%) received TH and 47 (58.8%) received NH. Fourteen (17.5%) had pCR at surgery. Most (96.3%) received anthracycline-based adjuvant chemotherapy; 78.7% of NH patients also received adjuvant trastuzumab. At a median follow-up of 8.8 years, 23 (28.8%) patients have experienced recurrence, with 16 breast cancer-related deaths. Four-year RFS in patients with pCR was 92.9% (95% confidence interval [CI], 79.4%-100%) versus 72.4% without pCR (95% CI, 63.9%-82.1%). All initial symptomatic cardiotoxicity resolved during extended follow-up. New symptomatic cardiotoxicity in long-term follow-up was rare, primarily occurring in patients requiring retreatment with a cardiotoxic agent.

CONCLUSION:

Neoadjuvant chemotherapy and trastuzumab for HER2-positive breast cancer resulted in favorable long-term survival with minimal late toxicity. Trends in this data set suggest an association between pCR and improved long-term RFS. Retreatment with cardiotoxic agents might increase risk of late cardiotoxicity.

KEYWORDS:

Anthracycline; Cardiotoxicity; Neoadjuvant therapy; Pathologic complete response

PMID:
25205424
DOI:
10.1016/j.clbc.2014.07.010
[Indexed for MEDLINE]

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