Pathologic complete response to preoperative sequential foxorubicin/cyclophosphamide and single-agent taxane with or without trastuzumab in stage II/III HER2-positive breast cancer

Saranya Chumsri, Stacie Jeter, Lisa K. Jacobs, Hind Nassar, Deborah K. Armstrong, Leisha A. Emens, John H. Fetting, Julie R. Lange, Carol Riley, Theodore N. Tsangaris, Antonio C. Wolff, Richard Zellars, Zhe Zhang, Vered Stearns

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Background: Four major clinical trials have established that trastuzumab added to adjuvant systemic chemotherapy for women with HER2+ breast cancer significantly improves disease-free and overall survival compared with chemotherapy alone. We evaluated pathologic complete response (pCR) rate and cardiac safety of preoperative doxorubicin and cyclophosphamide followed by a taxane with or without trastuzumab. Patients and Methods: We reviewed pCR rate and change in left ventricular ejection fraction in women with operable HER2+ breast cancer (defined as immunohistochemical 3+ or fluorescence in situ hybridization ratio ≥ 2.2) who were treated between 2002 and 2008 with doxorubicin and cyclophosphamide followed by a taxane with or without trastuzumab before definitive breast surgery. Results: We identified 33 patients, of whom 42.4% received preoperative chemotherapy without trastuzumab and 57.6% of whom received trastuzumab with chemotherapy. The pCR rates were 28.6% and 52.6% in the group that received chemotherapy alone or with trastuzumab, respectively (odds ratio, 2.78; 95% CI, 0.64-12.1; P = .173). Severe cardiac events or treatment delays as a result of cardiac toxicity were not observed. With a median follow-up time of 14 months, 21.4% of patients in the non-trastuzumab group and 10.5% in the trastuzumab group had disease recurrence. Conclusion: Sequential administration of preoperative doxorubicin and cyclophosphamide followed by a taxane and trastuzumab combination is safe in women with primary operable HER2+ breast cancer and is associated with a high pCR rate. Large randomized phase III clinical trials are evaluating the role of preoperative trastuzumab when added to anthracycline- and/or taxane-based regimens.

Original languageEnglish (US)
Pages (from-to)40-45
Number of pages6
JournalClinical breast cancer
Volume10
Issue number1
DOIs
StatePublished - Feb 1 2010

Keywords

  • Monoclonal antibody
  • Neoadjuvant therapy
  • Primary chemotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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