Short-course adjuvant trastuzumab in breast cancer: Experience from a tertiary cancer center in rural India

Abstract

Introduction: Majority of the patients in low-to-middle income countries (LMICs) have no access to adjuvant trastuzumab due to financial constraints. Short-course (9 weeks) schedule of trastuzumab is a feasible alternative in this setting. The objective of this study was to assess the feasibility and outcomes of adjuvant short-course trastuzumab in patients with breast cancer treated at our center.Materials and Methods: This was a retrospective study conducted in a tertiary cancer center in South India. Case records of all patients who received short-course (9 weeks) adjuvant trastuzumab from June 2014 to December 2016 were reviewed. Baseline characteristics, treatment details, and outcomes were analyzed.Results: During the study, 129 patients received short-course trastuzumab. The median age was 50 years (range, 30–74 years). Majority of the patients were postmenopausal (64%). The most common histology was infiltrating ductal carcinoma; 57% had Grade 2 disease. The most common chemotherapy regimen used was doxorubicin + cyclophosphamide (AC), followed by weekly paclitaxel (n = 110, 86%) and docetaxel + cyclophosphamide (TC) (n = 17, 13%). Majority of the patients (n = 120, 93%) had T1 or T2 disease and were node-negative (n = 62, 57%). Sixty-two patients (48%) had hormone receptor-positive disease. One hundred and eight patients (84%) underwent modified radical mastectomy, and the rest had breast conservation surgery. At a median follow-up of 29 months, the 3-year overall survival (OS) was 98%; the median OS was not reached. The 3-year disease-free survival (DFS) was 97.4%; the median DFS was not reached. The regimen was well tolerated and none of the patients developed symptomatic cardiac failure.Conclusions: Our study shows that a 9-week short course of trastuzumab is a feasible strategy in a resource-limited setting and can lead to promising outcomes, especially in early breast cancer.