Long-term follow-up of HER2-overexpressing stage II or III breast cancer treated by anthracycline-free neoadjuvant chemotherapy — Ann Oncol

Ann Oncol (2011) 22 (2): 321-328.
doi: 10.1093/annonc/mdq397
First published online: August 6, 2010

Long-term follow-up of HER2-overexpressing stage II or III breast cancer treated by anthracycline-free neoadjuvant chemotherapy

S. Guiu1, M. Liegard1, L. Favier1, I. van Praagh2, R. Largillier3, B. Weber4, D. Coeffic5, L. Moreau6, F. Priou7, M. Campone8, J. Gligorov9, L. Vanlemmens10, V. Trillet-Lenoir11, L. Arnould1 and B. Coudert1,*


+ Author Affiliations
1Departments of Medical Oncology, Medical Information, Pathology, CAC GF Leclerc, IFR 100, Dijon
2Department of Medical Oncology, CAC Jean Perrin, Clermont Ferrand
3Department of Medical Oncology, CAC Antoine Lacassagne, Nice
4Department of Medical Oncology, CAC A Vautrin, Nancy
5Department of Medical Oncology, Institut Daniel Hollard, Grenoble
6Department of Medical Oncology, Clinique des Domes, Clermont Ferrand
7Department of Medical Oncology, CH Les Oudairies, La Roche sur Yon
8Department of Medical Oncology, CAC Rene Gauducheau, Nantes
9Department of Medical Oncology, CHU Tenon, Paris
10Department of Medical Oncology, CAC O Lambret, Lille
11Medical Oncology Unit, Centre Hospitalier Lyon Sud, Pierre-Benite; Lyon 1 University, EA3738, CTO, Oullins, France


*Correspondence to: Dr B. Coudert, Department of Medical Oncology, Centre GF Leclerc, 1 rue du Pr Marion, 21000 Dijon, France. Tel: +33-380-737-720; Fax: +33-380-737-712; E-mail: bcoudert@cgfl.fr

Received April 28, 2010.
Revision received May 25, 2010.
Accepted May 26, 2010.

Abstract
Background: Very effective trastuzumab-based primary systemic therapy (PST) can be proposed for conservative surgery purpose to human epidermal growth factor receptor 2 (HER2)-positive breast cancer (HER2+BC). Long-term follow-up (LTFU) warrants further data.

Patients and methods: LTFU of patients, with stage II/III HER2+BC, treated by trastuzumab associated with docetaxel (Taxotere®) and/or carboplatin used as anthracycline-free PST was studied.

Results: Among 135 patients, with a median follow-up of 48.3 months [95% confidence interval (CI) 45.3–52.4 months], the relapse-free survival (RFS) rate was 73.2% (95% CI 63.76% to 80.55%) while the overall survival (OS) rate was 91.87% (95% CI 84.23% to 95.90%). Adjuvant trastuzumab favorably influenced RFS in univariate analysis while the pathological nodal invasion unfavorably influenced RFS [Cox multivariate analysis (hazard ratio = 2.80, 95% CI 1.36–5.76, P = 0.0052)] and OS. Cardiac toxicity was minor (2.2% transient, reversible asymptomatic decrease in left ventricular ejection fraction).

Conclusion: This is the first report of LTFU showing that anthracycline-free trastuzumab-based PST combined either with docetaxel and/or carboplatin can achieve, without cardiac toxicity, very competitive results in terms of pathological complete response, RFS and OS, in HER2+BC. The choice of this schedule could be proposed to patients with vascular contraindication for anthracyclines or because patient's or physician's preference for a taxane-only schedule.

Long-term follow-up of HER2-overexpressing stage II or III breast cancer treated by anthracycline-free neoadjuvant chemotherapy — Ann Oncol