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BackgroundNeoadjuvant therapy, which aims to achieve a pathological complete response (pCR) for better overall survival (OS) has several advantages for patients with early breast cancer (eBC) and subtypes of HER2-positive (HER2+) and triple-negative breast cancer (TNBC). However, there has been no large-scale real-world investigation on the clinical outcomes associated with trastuzumab-based and platinum-based neoadjuvant treatments for patients with HER2+ and TNBC, respectively.Material and methodsTaiwan Cancer Registry and National Health Insurance Research Database were utilized in this study. Patients diagnosed with clinically lymph-node-positive (LN+) HER2+ or TNBC were identified for analysis. Logistic regression and Cox proportional hazard models were employed to estimate the adjusted odds ratios (aOR) of achieving pCR and adjusted hazard ratios (aHR) of overall survival associated with treatment agents, respectively.ResultsA total of 1,178 HER2+ eBC and 354 early TNBC patients were identified, respectively. Neoadjuvant trastuzumab significantly increased the pCR rates by 3.87-fold among HER2+ patients. Trastuzumab-associated survival benefit was found in HER2+ patients who achieved pCR (aHR [95% CI]: 0.30 [0.11-0.84]) but not in those without pCR (1.13 [0.77-1.67]). Among the TNBC patients, platinum was associated with a 1.6-fold increased pCR rate; however, it did not improve OS regardless of pCR status.ConclusionsTrastuzumab improved pCR and OS for patients with HER2+ subtype. Using platinum agents for TNBC patients increased pCR rates but was not linked to better survival. Optimal neoadjuvant anti-HER2 therapy for patients with HER2+ eBC and the introduction of novel therapy for patients with TNBC should be considered.

Rituximab/bendamustine (RB) and rituximab/ifosfamide/carboplatin/etoposide (R-ICE) are commonly used to treat relapsed/refractory diffuse large B-cell lymphoma (DLBCL), although their effectiveness has not been compared in real-world practice. This study evaluated data from DLBCL patients who relapsed after or were refractory to first-line therapy in an electronic health record (EHR)-derived database between 2011 and 2018. One hundred thirty-seven patients using RB and 270 patients using R-ICE were included for analysis. Transplantation after second-line therapy was considered a censored event in the time-to-event analyses. Patients in the RB group were older and had poorer performance status while there were no significant differences in stage, cell of origin, and double-/triple-hit subtypes. Relative to the R-ICE group, the RB group had significantly longer time-to-next-treatment (TTNT) and overall survival (OS). Subgroup analyses revealed that patients who were <70 years or had better performance status consistently had better TTNT and OS if they had received RB. Patients who had disease progression within 12 months after induction chemotherapy had a significantly inferior prognosis, regardless of the salvage treatments. Multivariable analysis revealed that RB treatment independently predicted better TTNT and OS. These data indicate that RB may be an alternative to R-ICE as second-line therapy for selected DLBCL patients.