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Long-term follow-up after preoperative trastuzumab and chemotherapy for HER2-overexpressing breast cancer
- Source :
- Clinical breast cancer. 15(1)
- Publication Year :
- 2014
-
Abstract
- Background Neoadjuvant chemotherapy and trastuzumab is an established treatment for locally advanced HER2-positive breast cancer, providing favorable rates of clinical response and pCR. Minimal data describe long-term outcomes after neoadjuvant HER2-directed therapy. This study aimed to explore long-term efficacy and toxicity after neoadjuvant trastuzumab and chemotherapy for HER2-positive breast cancer. Patients and Methods Eligible patients participated in 1 of 2 single-arm phase II neoadjuvant trials, receiving either paclitaxel/trastuzumab (TH) or vinorelbine/trastuzumab (NH) for stage II-III HER2-positive disease. Postoperative chemotherapy, with or without trastuzumab, was offered. Charts were reviewed to identify recurrence, death, and treatment-related toxicities. Association of long-term outcomes with baseline characteristics and pathological response to primary therapy was explored. Results Eighty patients were identified; 33 (41.3%) received TH and 47 (58.8%) received NH. Fourteen (17.5%) had pCR at surgery. Most (96.3%) received anthracycline-based adjuvant chemotherapy; 78.7% of NH patients also received adjuvant trastuzumab. At a median follow-up of 8.8 years, 23 (28.8%) patients have experienced recurrence, with 16 breast cancer-related deaths. Four-year RFS in patients with pCR was 92.9% (95% confidence interval [CI], 79.4%-100%) versus 72.4% without pCR (95% CI, 63.9%-82.1%). All initial symptomatic cardiotoxicity resolved during extended follow-up. New symptomatic cardiotoxicity in long-term follow-up was rare, primarily occurring in patients requiring retreatment with a cardiotoxic agent. Conclusion Neoadjuvant chemotherapy and trastuzumab for HER2-positive breast cancer resulted in favorable long-term survival with minimal late toxicity. Trends in this data set suggest an association between pCR and improved long-term RFS. Retreatment with cardiotoxic agents might increase risk of late cardiotoxicity.
- Subjects :
- Oncology
Adult
Cancer Research
medicine.medical_specialty
Anthracycline
Receptor, ErbB-2
medicine.medical_treatment
Breast Neoplasms
Vinorelbine
Antibodies, Monoclonal, Humanized
Disease-Free Survival
Breast cancer
Trastuzumab
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
Medicine
Humans
Stage (cooking)
skin and connective tissue diseases
Neoadjuvant therapy
Mastectomy
Cardiotoxicity
Chemotherapy
business.industry
Middle Aged
medicine.disease
Neoadjuvant Therapy
Up-Regulation
Treatment Outcome
Chemotherapy, Adjuvant
Preoperative Period
Female
business
medicine.drug
Follow-Up Studies
Subjects
Details
- ISSN :
- 19380666
- Volume :
- 15
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Clinical breast cancer
- Accession number :
- edsair.doi.dedup.....b70c6bf42a108e5afc59ceb2a75139eb