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Anthracycline Use in Neoadjuvant Therapy for HER2-Positive Breast Cancer

By: Lauren Harrison, MS
Posted: Thursday, February 7, 2019

When comparing neoadjuvant chemotherapy with and without anthracyclines for HER2-positive breast cancer, no difference was noted in the pathologic complete response rate. Mette S. van Ramshorst, MD, of the Netherlands Cancer Institute, Amsterdam, and colleagues reported these results in The Lancet Oncology and highlighted that anthracycline treatment was associated with more frequent febrile neutropenia.

“Omitting anthracyclines from neoadjuvant treatment regimens might be a preferred approach in the presence of dual HER2 blockade in patients with early HER2-positive breast cancer,” concluded the authors.  

The TRAIN-2 open-label trial collected information on 418 evaluable patients with previously untreated stage II to III HER2-positive breast cancer from 37 different hospitals in the Netherlands. Patients were randomly assigned to receive either fluorouracil (500 mg/m²), epirubicin (90 mg/m²), and cyclophosphamide (500 mg/m²) every 3 weeks for 3 cycles followed by paclitaxel (80 mg/m² on days 1 and 8) and carboplatin every 3 weeks for 6 cycles (n = 212) or 9 cycles of paclitaxel and carboplatin at the same dose and schedule as in the anthracycline group (n = 206). Both groups also received trastuzumab and pertuzumab with all chemotherapy cycles.

After a median of 19 months, pathologic complete response was seen in 67% of patients in the anthracycline group and 68% of patients in the nonanthracycline group. Serious adverse events were observed in 28% of patients in the anthracycline group and 22% of patients in the nonanthracycline group. The most common adverse event was grade 3 or worse neutropenia, which was seen in 60% of patients who received anthracycline and 31% of patients who did not. Febrile neutropenia was more common with than without anthracycline (10% vs 1%). Other adverse effects included diarrhea (12% vs 18%) and peripheral neuropathy (30% vs 31%).

Disclosure: The study authors’ disclosure information may be found at thelancet.com.



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