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

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.

• Authors: Laura Spring, Andrzej Niemierko, Stephanie Haddad, Megan Yuen, Amy Comander, Kerry Reynolds, Jennifer Shin, Atul Bahn, Elena Brachtel, Michelle Specht, Barbara L Smith, Alphonse Taghian, Rachel Jimenez, Jeffrey Peppercorn, Steven J Isakoff, Beverly Moy, Aditya Bardia
• Journal: Breast cancer research and treatment (Breast Cancer Res Treat) Vol. 172 Issue 3 Pg. 733-740 (Dec 2018) ISSN: 1573-7217 [Electronic] Netherlands
• PMID: 30220055 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal, Humanized
• ERBB2 protein, human
• Receptor, ErbB-2
• pertuzumab

Topics

• Adult
• Aged
• Antibodies, Monoclonal, Humanized (administration & dosage, adverse effects)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Breast Neoplasms (chemistry, drug therapy, pathology)
• Female
• Humans
• Middle Aged
• Neoadjuvant Therapy
• Receptor, ErbB-2 (analysis)
• Stroke Volume (drug effects)
• Ventricular Function, Left (drug effects)