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Alliance Study: Comparing Neoadjuvant Therapy Approaches in HER2-Positive Breast Cancer

By: Celeste L. Dixon
Posted: Monday, November 12, 2018

Whether women with HER2-positive breast cancer received neoadjuvant anthracycline-based chemotherapy and trastuzumab concurrently or sequentially, disease-free survival and overall survival rates were no different after a median follow-up of 5 years, according to the results of the ACOSOG Z1041 (Alliance) randomized clinical trial, involving 280 patients. In JAMA Oncology, the investigators indicated that concurrent administration of trastuzumab with fluorouracil, epirubicin, and cyclophosphamide (FEC) offered no “additional clinical benefit and is not warranted.”

“Our findings…allow for all women with this class of breast cancer to be spared of cardiotoxicities associated with anthracycline and trastuzumab given at the same time,” stated Kelly K. Hunt, MD, of The University of Texas MD Anderson Cancer Center in Houston, in an institutional press release.  

The concurrent regimen was paclitaxel plus trastuzumab followed by FEC plus trastuzumab, and the sequential regimen was FEC followed by paclitaxel plus trastuzumab.Women with hormone receptor–positive disease received endocrine therapy, and radiotherapy was delivered at physician discretion,” the authors noted. The median age of patients was 50 years; 82.9% were white.

The P values for the differences in outcomes for the two regimens were 0.96 (disease-free survival) and 0.73 (overall survival). In addition, the authors had previously reported that pathologic complete response did not differ between arms.

These research results “offer physicians definitive clinical guidance,” stated Dr. Hunt. “Many have opted to treat with a more aggressive approach because the patient’s disease was a higher stage or because of the woman’s young age. Our study confirms that for HER2-positive breast cancer patients, less is more.”



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