Neoadjuvant docetaxel/carboplatin/trastuzumab/pertuzumab (TCHP) in patients with HER2-positive early or locally advanced breast cancer

Abstract

The widespread use of anti-HER2 drugs has fundamentally changed the fate of patients with both early and metastatic HER2-positive breast cancer (BC). The results of clinical studies demonstrate a significant increase in the frequency of achieving complete pathological response (pCR) and, as a consequence, improved survival rates when using the combination of docetaxel + carboplatin + trastuzumab + pertuzumab (TCHP) in neoadjuvant chemotherapy for HER2+ breast cancer, which is reflected in modern domestic and international guidelines. The purpose of this study was to evaluate the effectiveness of the TCHP regimen, as well as to identify independent clinical and morphological factors in achieving pCR. The study included 234 patients with HER2-positive breast cancer of stages II and III who received TCHP regimen in neoadjuvant setting, 233 were operated. The rate of achieving complete pathomorphological response (pCR, RCB 0) was 63 %, in the nonluminal HER2-positive subtype – 76 %, in the luminal HER2-positive subtype – 55 %. Predictors of pCR were the absence of hormonal receptors in the tumor (OR = 1.72; 95 % CI: 1.17–2.54; р = 0,01), as well as a high (>50 %) Ki-67 proliferation index (OR = 1.4; 95 % CI: 1.01–1.98; р = 0,05). The use of granulocyte colony stimulating factor as primary prevention has reduced the risk of febrile neutropenia and mucositis. Further observation of patients will allow us to evaluate the long-term results of neoadjuvant therapy for HER2-positive breast cancer using the TCHP regimen in our population.