Anthracycline versus nonanthracycline adjuvant therapy for early breast cancer

Ding, Wu; Li, Zhaojun; Wang, Caiyun; Dai, Jiangfeng; Ruan, Guodong; Tu, Chuanjian

doi:10.1097/md.0000000000012908

Cited by 19 publications

(19 citation statements)

References 33 publications

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“…[3] In the TRAIN 2 study, there was no signi cant difference between the regimen containing anthracyclines and the regimen that did not, and it was reported that it was preferable not to use anthracyclines. [13] The pathological complete response rates obtained in our study was found to be similar in anthracycline containing and not containing regimen groups. All patients with cardiotoxicity (5.8%) were patients who had received the treatment regimen containing anthracycline.…”

Section: Discussionsupporting

confidence: 73%

Chemotherapy Choice in Neoadjuvant Dual Her2 Blockade; is it Really Necessary to add Anthracycline?

Özveren

Erdoğan

Ekinci

et al. 2021

Preprint

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1. BackgroundAddition of trastuzumab and pertuzumab to neoadjuvant chemotherapy in human epidermal growth factor receptor 2(HER-2) positive patients is the current clinical standard today. In studies on neoadjuvant chemotherapy, the primary endpoint is pathological complete response (pCR). More real-life data are needed to answer whether the presence of anthracycline in the chemotherapy regimen enhances complete response with neoadjuvant dual HER-2 blockade, and whether cardiotoxicity increases with dual HER-2 blockade after anthracycline.2. Methods52 patients with HER-2 positive breast cancer who received neoadjuvant chemotherapy were retrospectively evaluated. Three centers participated in the study (İzmir Kent Hospital, Manisa Celal Bayar University, Ege University). The effects of chemotherapy regimen and several other factors such as age, stage, menopause status, lymph node positivity, hormone receptor positivity on pCR were evaluated. Also presence of cardiotoxicity was evaluated.3. ResultsThe mean age of diagnosis was 46 ± 9 (range: 26-67), and 50% (26) of the patients were postmenopausal. The pCR rate was 71.2% (37) in the entire study group. In terms of pCR, there was no significant difference between those who use an anthracycline containing and non-anthracycline containing regimens (71.4% vs 70%, p=1.000), those with negative and positive hormone receptors (64.7% vs 74.3%, p=0.525), those with Ki67 levels of %20 or less and those over 20% (60% vs 73.8%, p=0.447), premenopausal and postmenopausal ones (76.9% vs 65.4%, p=0.054). 4. ConclusionsAs a result of the data we obtained, it was concluded that adding anthracycline regimen to dual HER-2 blockade in the neoadjuvant period did not bring additional benefits in terms of pCR. Additional studies are needed on whether the use of anthracycline-containing regimen contributes additionally in patients who will use the neoadjuvant pertuzumab-trastuzumab combination.

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Section: Discussionsupporting

confidence: 73%

Chemotherapy Choice in Neoadjuvant Dual Her2 Blockade; is it Really Necessary to add Anthracycline?

Özveren

Erdoğan

Ekinci

et al. 2021

Preprint

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“…And during these cycles, all of our study participants received only Adriamycin and cyclophosphamide from both regimens. Recent systematic review and meta-analysis indicated that both hematological (i.e., neutropenia and others) and nonhematological toxicities (i.e., nausea, vomiting, and mucositis) were common in anthracycline (Adriamycin) containing regimen for breast cancer [20]. e epithelium covering the entire gastrointestinal tract (GIT) is rapidly dividing, and thus it is highly susceptible to chemotherapy which leads to probably the most feared adverse effects, nausea and vomiting [21].…”

Section: Discussionmentioning

confidence: 99%

Patterns of Anthracycline-Based Chemotherapy-Induced Adverse Drug Reactions and Their Impact on Relative Dose Intensity among Women with Breast Cancer in Ethiopia: A Prospective Observational Study

Alemayehu

Assefa

Tefera

et al. 2020

Journal of Oncology

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Background. e breast cancer chemotherapy leads to diverse aspects of noxious or unintended adverse drug reactions (ADRs) that cause the relative dose intensity (RDI) reduced to below optimal (i.e., if the percentage of actual dose received per unit time divided by planned dose per unit time is less than 85%). Hence, this prospective observational study was conducted to evaluate chemotherapy-induced ADRs and their impact on relative dose intensity among women with breast cancer in Ethiopia.Methods. e study was conducted with a cohort of 146 patients from January 1 to September 30, 2017, Gregorian Calendar (GC) at the only nationwide oncology center, Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. e ADRs of the chemotherapy were collected using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) (version 4.03). e patients were personally interviewed for subjective toxicities, and laboratory results and supportive measures were recorded at each cycle. SPSS version 22 was used for analysis. Results. Grade 3 neutropenia (23 (15.8%)) was the most frequently reported ADR among grade 3 hematological toxicity on cycle 4. However, overall grade fatigue (136 (93.2%)) and grade 3 nausea (31 (21.2%)) were the most frequently reported nonhematological toxicities on cycle 1. e majority of ADRs were reported during the first four cycles except for peripheral neuropathy. Oral antibiotics and G-CSF use (17 (11.6%)) and treatment delay (31 (21.2%)) were frequently reported on cycle 3. Overall, 61 (41.8%) and 42 (28.8%) of study participants experienced dose delay and used G-CSF, respectively, at least once during their enrollment. Of the 933 interventions observed, 95 (10%) cycles were delayed due to toxicities in which neutropenia attributed to the delay of 89 cycles. Forty-four (30.1%) of the patients received overall RDI < 85%. Pretreatment hematological counts were significant predictors (P < 0.05) for the incidence of first cycle hematological toxicities such as neutropenia, anemia, and leukopenia and nonhematological toxicities like vomiting. Conclusion. Ethiopian women with breast cancer on anthracycline-based AC and AC-T chemotherapy predominantly experienced grade 1 to 3 hematological and nonhematological ADRs, particularly during the first four cycles. Neutropenia was the only toxicity that led to RDI < 85%. us, enhancing the utilization of G-CSF and other supportive measures will improve RDI to above 85%.

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“…In the adjuvant setting, anthracycline-containing regimens have been reported to be superior to non-anthracycline-containing regimens for both DFS and OS in patients with early breast cancer. 33 As NAC, anthracycline-containing regimens are reported to be associated with higher pCR rates but without statistical significance compared to non-anthracycline-containing regimens in patients with TNBC. 19 Although TNBC has been reported to be more sensitive to anthracycline-containing regimens than non-TNBC, 34 the real benefit of adding anthracycline to the NAT regimen in patients with TNBC has been controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Anthracyclines have been commonly used as a component in adjuvant or neo‐adjuvant therapy of breast cancer. In the adjuvant setting, anthracycline‐containing regimens have been reported to be superior to non–anthracycline‐containing regimens for both DFS and OS in patients with early breast cancer 33 . As NAC, anthracycline‐containing regimens are reported to be associated with higher pCR rates but without statistical significance compared to non–anthracycline‐containing regimens in patients with TNBC 19 .…”

Section: Discussionmentioning

confidence: 99%

Neo‐adjuvant therapy for triple‐negative breast cancer: Insights from a network meta‐analysis

et al. 2020

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Background: The best regimen of neo-adjuvant therapy for triple-negative breast cancer (TNBC) is unknown. Recent studies have shown promising data that adding carboplatin or pembrolizumab improves the rate of pathologic complete response (pCR) in TNBC. Therefore, we performed a network meta-analysis to define the overall, most effective, neo-adjuvant systemic therapy for TNBC. Methods: We searched for studies comparing different neo-adjuvant regimens in patients with TNBC. We performed a network meta-analysis comparing the regimens using the random-effects model. We focused on anthracycline, bevacizumab, pembrolizumab, and platinum salts (Pl). All study regimens contained a taxane. We analyzed the rate of pCR (ypT0/is, N0), and the incidence of febrile neutropenia, grade 3-grade 4 thrombocytopenia, nausea/vomiting, and diarrhea. Results: We identified a total of 13 randomized control trials for this analysis. We compared ten different classes of regimens. We found that regimens containing Pl were significantly superior to non-PI-containing regimens for the rate of pCR. Similarly, pembrolizumab-containing regimens were associated with significantly higher pCR rates. Regimens containing bevacizumab significantly increased the rate of pCR as well. However, it was equivocal as to whether the addition of Pl to pembrolizumab-containing regimen increases pCR rates. Adding anthracycline into the regimen did not show an improved rate of pCR. In the safety analysis, regimens containing Pl were associated with a significantly higher incidence of febrile neutropenia and grade 3-grade 4 thrombocytopenia. The regimen containing anthracycline plus bevacizumab plus Pl was associated with a higher risk of gastrointestinal adverse events. Conclusions: For TNBC, regimens containing bevacizumab, pembrolizumab, or Pl are most effective in terms of pCR rates, though it is unclear whether combining all these medications has the greatest efficacy. Additionally, the benefit of using anthracycline in the neo-adjuvant therapy regimen for TNBC is not apparent, which may warrant a further head-to-head comparison.

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Anthracycline versus nonanthracycline adjuvant therapy for early breast cancer

Cited by 19 publications

References 33 publications

Chemotherapy Choice in Neoadjuvant Dual Her2 Blockade; is it Really Necessary to add Anthracycline?

Chemotherapy Choice in Neoadjuvant Dual Her2 Blockade; is it Really Necessary to add Anthracycline?

Patterns of Anthracycline-Based Chemotherapy-Induced Adverse Drug Reactions and Their Impact on Relative Dose Intensity among Women with Breast Cancer in Ethiopia: A Prospective Observational Study

Neo‐adjuvant therapy for triple‐negative breast cancer: Insights from a network meta‐analysis

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