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Breast Cancer Res Treat. 2018 Dec;172(3):733-740. doi: 10.1007/s10549-018-4959-8. Epub 2018 Sep 15.

Effectiveness and tolerability of neoadjuvant pertuzumab-containing regimens for HER2-positive localized breast cancer.

Author information

1
Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA.
2
Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit St., Boston, MA, 02114, USA. Bardia.Aditya@mgh.harvard.edu.

Abstract

PURPOSE:

Based on improvement in pathologic complete response (pCR) in the NeoSphere and TRYPHAENA studies, the FDA approved neoadjuvant pertuzumab for HER2+ localized breast cancer. These studies demonstrated high pCR rates with THP (docetaxel + HP), FEC (5-fluorouracil, epirubicin, and cyclophosphamide)-THP, and TCHP (docetaxel, carboplatin + HP). However, in the United States, doxorubicin/cyclophosphamide (AC) is favored over FEC despite no data comparing neoadjuvant AC-THP with AC-TH or TCHP. Here we report outcomes for patients with localized HER2+ breast cancer treated with pertuzumab-containing neoadjuvant regimens and AC-TH.

METHODS:

We reviewed clinicopathological characteristics of patients with HER2+ breast cancer (Stage I-III) treated with either a neoadjuvant pertuzumab-containing regimen or dose-dense (dd) AC-TH, from 2011 to 2016 at a large academic medical institution and two affiliated community sites. pCR was defined as ypT0/is ypN0. Fisher's exact test and logistic regression analysis were used for statistical analysis.

RESULTS:

In this study (N = 121), pCR was numerically higher with pertuzumab-based regimens, including ddAC-THP (60%), TCHP (63%), THP (55%), as compared with ddAC-TH (46%). THP resulted in significantly less cycle delays due to toxicity compared to the other regimens (p = 0.02). THP also resulted in the least dose reductions, lowest rate of hospitalization, and lowest rate of treatment discontinuation.

CONCLUSIONS:

Pertuzumab-based regimens, including THP, resulted in higher pCR rates as compared to ddAC-TH, with the THP regimen associated with the best tolerability among patients with localized HER2+ breast cancer. Given the various neoadjuvant regimens, additional studies are needed to determine optimal treatment sequencing and escalation/de-escalation strategies to personalize neoadjuvant regimens for localized HER2+ breast cancer.

KEYWORDS:

HER2; Neoadjuvant; Pathologic complete response; Pertuzumab; Trastuzumab

PMID:
30220055
PMCID:
PMC6235701
[Available on 2019-12-01]
DOI:
10.1007/s10549-018-4959-8
[Indexed for MEDLINE]

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