Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Dec 27:11:29-42.
doi: 10.2147/BCTT.S179750. eCollection 2019.

Primary systemic therapy in HER2-positive operable breast cancer using trastuzumab and chemotherapy: efficacy data, cardiotoxicity and long-term follow-up in 142 patients diagnosed from 2005 to 2016 at a single institution

Silvia Antolín  1 , Benigno Acea  2 , Luis Albaina  2 , Ángel Concha  3 , Paz Santiago  3 , Tomás García-Caballero  4 , Joaquín J Mosquera  5 , José Ramón Varela  5 , Rafaela Soler  5 , Lourdes Calvo  1
Affiliations

Primary systemic therapy in HER2-positive operable breast cancer using trastuzumab and chemotherapy: efficacy data, cardiotoxicity and long-term follow-up in 142 patients diagnosed from 2005 to 2016 at a single institution

Silvia Antolín et al. Breast Cancer (Dove Med Press). .

Abstract

Objective: The aim of this study was to evaluate the efficacy, cardiotoxicity profile and long-term benefits of neoadjuvant therapy in human epidermal growth factor receptor 2-positive operable breast cancer patients.

Patients and methods: A total of 142 patients diagnosed from 2005 to 2016 were included in the study. The treatment consisted of a sequential regimen of taxanes and anthracyclines plus trastuzumab. The clinical and pathological responses were evaluated and correlated with clinical and biological factors. The cardiotoxicity profile and long-term benefits were analyzed.

Results: The median age was 49 years, and 4%, 69% and 27% of patients had stage I, II and III breast cancer, respectively, while 10% had inflammatory breast cancer at diagnosis. Hormone receptor (HR) status was negative in 43%, and 62% had grade III breast cancer. The clinical complete response rate was 49% and 63% as assessed using ultrasound and magnetic resonance imaging, respectively, and this allowed a high rate of conservative surgery (66%). The pathological complete response (pCR) rate was 52%, and it was higher in HR-negative (64%) patients than in HR-positive (41%) patients and in grade III breast cancer (53%) patients than in grade I-II breast cancer (45%) patients. Patients who achieved pCR had longer disease-free survival and a trend toward improved overall survival. A total of 2% of patients showed a 10% decrease in left ventricular ejection fraction to <50% during treatment. All patients except one recovered after discontinuation of trastuzumab.

Conclusion: A sequential regimen of taxanes and anthracyclines plus trastuzumab was effective, with high pCR rates and long-term benefit, and had a very good cardiotoxicity profile.

Keywords: HER2-positive breast cancer; cardiotoxicity; neoadjuvant therapy; pathological complete response; survival.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Types of chemotherapy. Notes: *Chemotherapy doses. Paclitaxel: 80 mg/m2, weekly ×12 doses. FEC: 5-fluorouracil: 600 mg/m2/epirubicin: 75 mg/m2/cyclophosphamide: 600 mg/m2 every 3 weeks × four cycles. Myocet: 60 mg/m2/cyclophosphamide: 600 mg/m2/every 3 weeks × four cycles. T: 8 mg/kg IV loading dose followed by 6 mg/kg IV every 3 weeks (a total of 12 months, including in the neoadjuvant and adjuvant setting). Abbreviations: FEC, 5-fluorouracil–epirubicin–cyclophosphamide; IV, intravenous; T, trastuzumab.
Figure 2
Figure 2
DFS assessed using the Kaplan–Meier method. Abbreviation: DFS, disease-free survival.
Figure 3
Figure 3
OS assessed using the Kaplan–Meier method. Abbreviation: OS, overall survival.
Figure 4
Figure 4
DFS based on pCR. Abbreviations: DFS, disease-free survival; pCR, pathological complete response.
Figure 5
Figure 5
OS based on pCR. Abbreviations: OS, overall survival; pCR, pathological complete response.
Figure 6
Figure 6
Basal LVEF at the end of chemotherapy and follow-up. Abbreviation: LVEF, left ventricular ejection fraction.
See this image and copyright information in PMC

References

    1. Hortobagyi GN, Blumenschein GR, Spanos W, et al. Multimodal treatment of locoregionally advanced breast cancer. Cancer. 1983;51(5):763–768. - PubMed
    1. Hortobagyi GN, Ames FC, Buzdar AU, et al. Management of stage III primary breast cancer with primary chemotherapy, surgery, and radiation therapy. Cancer. 1988;62(12):2507–2516. - PubMed
    1. Bear HD. Indications for neoadjuvant chemotherapy for breast cancer. Semin Oncol. 1998;25(2 Suppl 3):3–12. - PubMed
    1. Rastogi P, Anderson SJ, Bear HD, et al. Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27. J Clin Oncol. 2008;26(5):778–785. - PubMed
    1. Mauri D, Pavlidis N, Ioannidis JP. Neoadjuvant versus adjuvant systemic treatment in breast cancer: a meta-analysis. J Natl Cancer Inst. 2005;97(3):188–194. - PubMed