Dose-dense paclitaxel plus carboplatin in combination with trastuzumab neoadjuvant versus standard adjuvant therapy in human epidermal growth factor receptor-2 positive and hormone receptor negative breast cancer: a prospective cohort study.
10.3760/cma.j.cn112152-20221006-00678
- Author:
Meng XIU
1
;
Yao LU
2
;
Xiang WANG
3
;
Ying FAN
1
;
Qiao LI
1
;
Qing LI
1
;
Jia Yu WANG
1
;
Yang LUO
1
;
Rui Gang CAI
1
;
Shan Shan CHEN
1
;
Peng YUAN
1
;
Fei MA
1
;
Bing He XU
1
;
Pin ZHANG
1
Author Information
1. Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
2. Department of Medical Oncology, the First People's Hospital of Nanning, Nanning 530016, China.
3. Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
- Publication Type:Journal Article
- Keywords:
Anthracyclines;
Breast neoplasms;
Dose-dense chemotherapy;
Epidermal growth factor receptor-2;
Hormone receptor;
Neoadjuvant therapy
- MeSH:
Female;
Humans;
Anthracyclines/therapeutic use*;
Antibiotics, Antineoplastic/therapeutic use*;
Antineoplastic Combined Chemotherapy Protocols/therapeutic use*;
Carboplatin/therapeutic use*;
Chemotherapy, Adjuvant;
Hormones/therapeutic use*;
Neoadjuvant Therapy;
Paclitaxel/therapeutic use*;
Prospective Studies;
Receptor, ErbB-2/metabolism*;
Trastuzumab/therapeutic use*;
Triple Negative Breast Neoplasms/drug therapy*
- From:
Chinese Journal of Oncology
2023;45(8):709-716
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To provide survival evidence of anthracycline-free neoadjuvant chemotherapy for patients with stages Ⅱ-Ⅲ human epidermal growth factor receptor-2 (HER-2) positive and hormone receptor (HR) negative breast cancer. Methods: The prospective cohort study was conducted at the Department of Medical Oncology of Cancer Hospital, Chinese Academy of Medical Sciences. Patients with HER-2 positive and HR negative breast cancer in stages Ⅱ-Ⅲ were enrolled to receive neoadjuvant therapy (NAT) of dose-dense paclitaxel (175 mg/m(2)) plus carboplatin (AUC=4.0) biweekly for 6 cycles in combination with trastuzumab (PCbH), and matched patients who received standard adjuvant therapy of physicians' choice were recruited for survival and safety comparison. Results: From July 2013 to November 2019, 166 patients were included (neoadjuvant 51, adjuvant 115). Compared with those who received adjuvant therapy, patients receiving NAT were younger (<35 years: 19.6% vs 5.2%, P=0.014), had larger tumors (T3: 62.7% vs 7.8%, P<0.001) and more advanced diseases (stage ⅡA: 2.0% vs 41.7%, P<0.001). Patients in the neoadjuvant group all received surgery, and 96 (83.5%) in the adjuvant group received anthracycline-and-taxane-containing regimens. A total of 98 patients (49 pairs) were matched, and the covariates between the two groups were acceptably balanced. Within a median follow-up of 46.5 (range, 14-87) months, the 4-year recurrence-free survival (RFS) rate among patients who received NAT was 73.3% (95% CI: 59.0%-87.6%), versus 80.6% (95% CI: 67.9%-93.3%) among those in the adjuvant group without statistical difference (P=0.418). A similar result was observed for the 4-year overall survival (OS) [neoadjuvant versus adjuvant: 91.5% (95% CI: 81.7%-100.0%) vs 97.8% (95% CI: 93.5%-100.0%), P=0.314]. Compared with standard adjuvant therapy, PCbH was related to less neutropenia and better cardiac safety. Conclusions: These results support the consideration of anthracycline-free neoadjuvant chemotherapy combined with anti-HER-2 therapy for patients with stages Ⅱ-Ⅲ HER-2-positive and HR-negative breast cancer. Optimized regimens with both efficacy and safety are needed and to be further investigated.
