TY - JOUR
T1 - Efficacy of neoadjuvant therapy with trastuzumab concurrent with anthracycline- and nonanthracycline-based regimens for HER2-positive breast cancer
AU - Bayraktar, Soley
AU - Gonzalez-Angulo, Ana M.
AU - Lei, Xiudong
AU - Buzdar, Aman U.
AU - Valero, Vicente
AU - Melhem-Bertrandt, Amal
AU - Kuerer, Henry M.
AU - Hortobagyi, Gabriel N.
AU - Sahin, Aysegul A.
AU - Meric-Bernstam, Funda
PY - 2012/5/1
Y1 - 2012/5/1
N2 - BACKGROUND: The aim of this study was to evaluate the pathologic complete response (pCR) rates and relapse-free survival (RFS) and overall survival (OS) of patients receiving neoadjuvant systemic therapy (NST) with trastuzumab in combination with an anthracycline- or nonanthracycline-based regimen. METHODS: In this retrospective nonrandomized study, the authors reviewed records of 300 patients with HER2-positive breast cancer treated with either sequential paclitaxel and trastuzumab and FEC75 in combination with trastuzumab (PH-FECH) or docetaxel, carboplatin, and trastuzumab (TCH). The Kaplan-Meier product-limit method was used to estimate RFS and OS rates. Logistic regression models and Cox proportional hazards models were fit to determine the associations between NST, pCR, and survival. RESULTS: There was no significant difference in the decline in cardiac ejection fraction; however, patients who received PH-FECH had fewer cardiac comorbidities at baseline (P =.002). pCR rates were 60.6% and 43.3% for patients who received PH-FECH (n = 235) and TCH (n = 65), respectively (P =.016). Patients who received PH-FECH were 1.45 times more likely to have a pCR (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.06-1.98; P =.02). Three-year RFS rates were 93% and 71% (P <.001), and 3-year OS rates were 96% and 86% (P =.008) for patients who received PH-FECH and TCH, respectively. Patients who received PH-FECH had a lower risk of recurrence (hazard ratio [HR], 0.27; 95% CI, 0.12-0.60; P =.001) and death (HR, 0.37; 95% CI, 0.12-1.13; P =.08) than those treated with TCH. CONCLUSIONS: The type of NST in HER2-positive breast cancer is predictive of pCR rate independent of disease and patient characteristics. Although TCH is active, PH-FECH shows a higher pCR rate and RFS advantage.
AB - BACKGROUND: The aim of this study was to evaluate the pathologic complete response (pCR) rates and relapse-free survival (RFS) and overall survival (OS) of patients receiving neoadjuvant systemic therapy (NST) with trastuzumab in combination with an anthracycline- or nonanthracycline-based regimen. METHODS: In this retrospective nonrandomized study, the authors reviewed records of 300 patients with HER2-positive breast cancer treated with either sequential paclitaxel and trastuzumab and FEC75 in combination with trastuzumab (PH-FECH) or docetaxel, carboplatin, and trastuzumab (TCH). The Kaplan-Meier product-limit method was used to estimate RFS and OS rates. Logistic regression models and Cox proportional hazards models were fit to determine the associations between NST, pCR, and survival. RESULTS: There was no significant difference in the decline in cardiac ejection fraction; however, patients who received PH-FECH had fewer cardiac comorbidities at baseline (P =.002). pCR rates were 60.6% and 43.3% for patients who received PH-FECH (n = 235) and TCH (n = 65), respectively (P =.016). Patients who received PH-FECH were 1.45 times more likely to have a pCR (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.06-1.98; P =.02). Three-year RFS rates were 93% and 71% (P <.001), and 3-year OS rates were 96% and 86% (P =.008) for patients who received PH-FECH and TCH, respectively. Patients who received PH-FECH had a lower risk of recurrence (hazard ratio [HR], 0.27; 95% CI, 0.12-0.60; P =.001) and death (HR, 0.37; 95% CI, 0.12-1.13; P =.08) than those treated with TCH. CONCLUSIONS: The type of NST in HER2-positive breast cancer is predictive of pCR rate independent of disease and patient characteristics. Although TCH is active, PH-FECH shows a higher pCR rate and RFS advantage.
KW - HER2-positive breast cancer
KW - anthracyclines
KW - neoadjuvant therapy
KW - pCR
KW - survival
KW - trastuzumab
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U2 - 10.1002/cncr.26555
DO - 10.1002/cncr.26555
M3 - Article
C2 - 21953213
AN - SCOPUS:84860223498
SN - 0008-543X
VL - 118
SP - 2385
EP - 2393
JO - Cancer
JF - Cancer
IS - 9
ER -