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

Agnieszka Irena Jagiełło-Gruszfeld,Aleksander Grous,Renata Sienkiewicz,Magdalena Rosinska,Katarzyna Pogoda,Anna Niwinska,Zbigniew I Nowecki,Paweł Winter,Małgorzata Meluch

doi:10.3390/cancers14051218

Agnieszka Irena Jagiełło-Gruszfeld, Aleksander Grous + Show 7 more

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https://doi.org/10.3390/cancers14051218

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Abstract

Simple SummaryNeoadjuvant chemotherapy in HER2-positive breast cancer has become the standard of care. Systemic treatment allows, in many cases, a reduction in the scope of surgical treatment. The aim of our retrospective study was to confirm the efficacy and safety of neoadjuvant chemotherapy in the TCbH-P program. All study patients received six courses of chemotherapy. All patients achieved a reduction in breast tumour size. There were no cardiac complications in any of the patients that prevented the continuation of treatment. A complete pathological response was achieved in 52.9% of patients. No pCR was achieved in any patient over 60 years of age with luminal B HER2-positive cancer, which questions the use of the TCbH-P regimen in this group of patients.Neoadjuvant systemic therapy has now become the standard in early breast cancer management. Chemotherapy in combination with trastuzumab +/− pertuzumab targeted therapy can improve the rates of pathologic complete response (pCR) in patients with HER2-positive breast cancer. Achieving a pCR is considered a good prognostic factor, in particular, in patients with more aggressive breast cancer subtypes such as TNBC or HER2-positive cancers. Furthermore, most studies demonstrate that chemotherapy in combination with trastuzumab and pertuzumab is well tolerated. The retrospective analysis presented here concentrates on neoadjuvant therapy with the TCbH-P regimen, with a particular emphasis on patients over 60 years of age. We analysed the factors affecting the achievement of pCR and present the adverse effects of the applied therapies, opening discussion about optimizing the therapy of older patients with HER-2 positive breast cancer.

Highlights

The diagnosis of breast cancer with high HER2 expression levels is associated with a worse prognosis and more dynamic disease progression
It is currently recommended that patients with HER2-positive cancer at high risk of recurrence or with HER2-positive locally advanced cancer should be treated with a combination of chemotherapy and dual anti-HER blockade, i.e., trastuzumab and pertuzumab [4,5,26]
Our study confirmed that the TCbH-P regimen is safe and relatively effective in the neoadjuvant treatment of patients with HER2-positive breast cancer

Summary

Introduction

Neoadjuvant therapy is the standard of care for most patients diagnosed with early HER2-positive breast cancer [1–3]. In the case of patients with a higher risk of recurrence, especially with confirmed axillary lymph node involvement and a lack of hormone receptors, the so-called dual anti-HER2 blockade with pertuzumab and trastuzumab in combination with chemotherapy is more effective than trastuzumab with chemotherapy [1–3]. Pertuzumab is a humanized monoclonal antibody that binds HER2 to a different epitope of the HER2 extracellular domain than trastuzumab, preventing HER2 dimerization with other ligand-activated HER2 receptors. The combination of pertuzumab, trastuzumab, and docetaxel improved pCR rates compared with trastuzumab and docetaxel therapies, from 21% to 39% [4,5]. Higher pCR rates are correlated with longer survival rates in this population [6,7]

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