Neoadjuvant Chemotherapy Without Anthracyclines Less Toxic for HER2+ Pateints

By David Costill
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A recent study in The Lancet Oncology found that removing anthracycline from neoadjuvant chemotherapy treatment regimens was equally as effective and reduced toxicity in dual HER2 blockadein patients with early HER2-positive breast cancer.

“The optimal chemotherapy backbone for dual HER2 blockade in the neoadjuvant setting for early breast cancer is unknown,” Mette S van Ramshorst, MD, department of medical oncology, Netherlands Cancer Institute, Amsterdam, and colleagues wrote. “We investigated whether the addition of anthracyclines would improve pathological complete response compared with a carboplatin–taxaneregimen, when given in combination with the HER2-targeted agents, trastuzumab and pertuzumab.”

​Scan. Source: iStock

The researchers conducted an open-label, randomized, controlled, phase III study across 37 medical centers in the Netherlands. They matched 438 patients into two treatment groups, 220 patients who received standard chemotherapy treatment with the inclusion of anthracycline and 218 patients who received nine cycles of paclitaxel and carboplatin without anthracycline.

All study patients also received trastuzumab and pertuzumab. Study participants were diagnosed with treatment-naïve, histologically confirmed stage II–III HER2-positive breast cancer.

Study results showed that pathological complete response rates were similar between the anthracycline group and the non-anthracycline group, at 68% and 67%, respectively.Additionally, serious adverse events were reported in 28% of the patients in the anthracycline group and in 22% of the patients in the non-anthracycline group.

The researchers noted that the most common adverse event was grade 3 neutropenia. Further, they found that febrile neutropenia was more common in the anthracycline group ( <P.001).

Additionally, one study patient died in the anthracycline group died of pulmonary embolism, likely caused by treatment.

“In view of the high proportion of pathological complete responses recorded in both groups and the fact that febrile neutropenia was more frequent in the anthracycline group, omitting anthracyclines from neoadjuvant treatment regimens might be a preferred approach in the presence of dual HER2 blockade in patients with early HER2-positive breast cancer,” van Ramshorst and colleagues concluded.