Neoadjuvant docetaxel with or without carboplatin plus dual HER2 blockade for HER2-positive breast cancer: a retrospective multi-center Chinese study

Abstract

Background: This study aimed to compare the real-world efficacy and safety of the TCbHP regimen (docetaxel, carboplatin, trastuzumab and pertuzumab) and the THP regimen (docetaxel, trastuzumab and pertuzumab) as neoadjuvant therapy for Chinese patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer. Methods: We compared efficacy and safety outcomes from 72 Chinese patients with HER2-positive breast cancer who underwent neoadjuvant dual HER2 blockade plus TCb or T chemotherapy and surgery between March 2019 and June 2020. Results: All 72 patients were women (32-76 years old) and the overall pathological complete response (pCR) rate was 70.8% (51/72). The pCR rates were 76.1% (35/46) for the TCbHP regimen and 61.5% (16/26) for the THP regimen (P=0.28). Univariate analyses revealed that pCR was associated with clinical T classification (P=0.024), AJCC stage (P=0.042), estrogen receptor (ER) status (P=0.002), progesterone receptor (PR) status (P=0.035), Ki-67 index (P<0.001), and immunohistochemical HER2 status (P<0.001).Multivariate analyses revealed that pCR was independently predicted by ER status (OR: 0.227, 95% CI: 0.053-0.852; P=0.032) and immunohistochemical HER2 status (OR: 43.673, 95% CI: 6.801-875.86; P<0.001). The common adverse events for both regimens included neutropenia, anemia, thrombocytopenia, nausea, and diarrhea. Relative to the THP group, the TCbHP group had higher frequencies of grade 3-4 thrombocytopenia (17% vs. 0%, P=0.044) and grade 3-4 diarrhea (15% vs. 0%, P=0.044). Both regimens had very good cardiac safety.Conclusions: These results suggest that both TCbHP and THP regimens may be useful neoadjuvant treatments for high-risk early or locally advanced HER2-positive breast cancer. Both regimens had generally good safety outcomes, although clinicians should be aware of the risks of grade 3-4 thrombocytopenia and diarrhea during TCbHP treatment. Elderly patients who require neoadjuvant therapy may benefit from 6 cycles of THP treatment, based on its good efficacy and mild adverse events.

Pathological response and predictive role of tumour-infiltrating lymphocytes in HER2-positive early breast cancer treated with neoadjuvant pyrotinib plus trastuzumab and chemotherapy (Panphila): a multicentre phase 2 trial

“…The use of carboplatin in our study might have also contributed to the difference. Carboplatin has been reported as part of the chemotherapy backbone for HER2-positive breast cancer [25,26]. The pCR rate in our study was also similar to that of pertuzumab plus TCH reported in the KRISTINE study (56%) [4].…”

Neoadjuvant Pertuzumab plus Trastuzumab in Combination with Docetaxel and Carboplatin in Patients with HER2 Positive Breast Cancer: Real-World Data from a National Institute of Oncology in Poland.

“…The most common adverse events found in our study were anaemia, weakness, neuropathy, and neutropenia. Diarrhoea was observed in our patients less frequently (26%) than in other studies, whereas most publications report the occurrence of diarrhoea in 40-56% of patients started on the treatment [8,9,27,32,33]. It should be noted, then, that we observed diarrhoea significantly more often in patients aged 60 years and older (71%) than in younger patients.…”

“…In observational studies describing the everyday clinical practice, patients with no significant co-existing medical conditions and being younger are often selected for treatment with dualblockade anti-HER2 regimens, in particular TCbH-P [32,33]. The results of our study support the validity of such choices since, in particular for the group of ER-positive patients, the benefit of using a relatively toxic TCbH-P regimen is unlikely to carry any extra benefits and may lead to serious complications.…”

Neoadjuvant pyrotinib plus nab-paclitaxel, doxorubicin, and cyclophosphamide for HER2-positive locally advanced breast cancer: a retrospective case-series study

“…Human epidermal growth factor receptor 2 (HER2)-positive breast cancer is an aggressive subtype, with higher risks of recurrence and metastasis, and worse prognosis (3,4). The use of anti-HER2 monoclonal antibody as (neo)adjuvant therapy has improved survival in patients with HER2-positive early or locally advanced breast cancer (5)(6)(7)(8)(9)(10).…”