Optimal use of anthracycline-free perioperative chemotherapy in HER2-positive breast cancer patients

Rurina Watanuki, Tetsu Hayashida, Yuko Kawai, Masayuki Kikuchi, Ayako Nakashoji, Takamichi Yokoe, Tomoka Toyota, Tomoko Seki, Maiko Takahashi, Yuukou Kitagawa

Research output: Contribution to journalArticle

Abstract

Purpose: In adjuvant settings of human epidermal growth factor receptor 2 (HER2)-positive breast cancer, anthracycline-based chemotherapy followed by taxane and trastuzumab is a standard regimen. Recent studies have reported the use of anthracycline-free adjuvant chemotherapy in selected HER2-positive breast cancer patients. We conducted a single-center retrospective study to identify the characteristics of HER2-positive breast cancer patients for whom anthracyclines can be safely omitted. Methods: A total of 238 women were diagnosed with HER2-positive breast cancer and treated with neoadjuvant and/or adjuvant chemotherapy between January 1, 2008 and December 31, 2015 at Keio University Hospital. They were divided in two cohorts: an “anthracycline” cohort of 112 anthracycline-treated women and a “no anthracycline” cohort of 126 anthracycline-untreated women. Survival outcomes were estimated by Kaplan–Meier method. Results: The 3-year disease-free survival rates in the no-anthracycline and anthracycline cohorts were 91.3% and 93.1%, respectively (P = 0.692). After using a statistical method with inverse probability of treatment weighting to minimize the selection bias, no significant differences were observed between the two cohorts (adjusted hazard ratio for disease-free survival: 1.042; P = 0.909). Stratified by tumor size, no significant differences were observed between the two cohorts in the cT1N0 and cT2N0 subsets (P = 0.516 and P = 0.579, respectively). The recurrence rate was low among patients who achieved pathological complete response after receiving neoadjuvant chemotherapy with or without anthracyclines. Conclusion: Our study suggests that anthracyclines can be safely omitted in selected patients with HER2-positive breast cancer, who have cT1N0 or cT2N0 and achieved pathological complete response after receiving neoadjuvant chemotherapy.

Original languageEnglish
JournalInternational Journal of Clinical Oncology
DOIs
Publication statusPublished - 2019 Jan 1

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Anthracyclines
Breast Neoplasms
Drug Therapy
Adjuvant Chemotherapy
Disease-Free Survival
human ERBB2 protein
Selection Bias
Survival Rate
Retrospective Studies
Recurrence

Keywords

  • Adjuvant chemotherapy
  • Anthracycline
  • HER2-positive breast cancer
  • Pathological complete response

ASJC Scopus subject areas

  • Surgery
  • Hematology
  • Oncology

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Optimal use of anthracycline-free perioperative chemotherapy in HER2-positive breast cancer patients. / Watanuki, Rurina; Hayashida, Tetsu; Kawai, Yuko; Kikuchi, Masayuki; Nakashoji, Ayako; Yokoe, Takamichi; Toyota, Tomoka; Seki, Tomoko; Takahashi, Maiko; Kitagawa, Yuukou.

In: International Journal of Clinical Oncology, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Purpose: In adjuvant settings of human epidermal growth factor receptor 2 (HER2)-positive breast cancer, anthracycline-based chemotherapy followed by taxane and trastuzumab is a standard regimen. Recent studies have reported the use of anthracycline-free adjuvant chemotherapy in selected HER2-positive breast cancer patients. We conducted a single-center retrospective study to identify the characteristics of HER2-positive breast cancer patients for whom anthracyclines can be safely omitted. Methods: A total of 238 women were diagnosed with HER2-positive breast cancer and treated with neoadjuvant and/or adjuvant chemotherapy between January 1, 2008 and December 31, 2015 at Keio University Hospital. They were divided in two cohorts: an “anthracycline” cohort of 112 anthracycline-treated women and a “no anthracycline” cohort of 126 anthracycline-untreated women. Survival outcomes were estimated by Kaplan–Meier method. Results: The 3-year disease-free survival rates in the no-anthracycline and anthracycline cohorts were 91.3{\%} and 93.1{\%}, respectively (P = 0.692). After using a statistical method with inverse probability of treatment weighting to minimize the selection bias, no significant differences were observed between the two cohorts (adjusted hazard ratio for disease-free survival: 1.042; P = 0.909). Stratified by tumor size, no significant differences were observed between the two cohorts in the cT1N0 and cT2N0 subsets (P = 0.516 and P = 0.579, respectively). The recurrence rate was low among patients who achieved pathological complete response after receiving neoadjuvant chemotherapy with or without anthracyclines. Conclusion: Our study suggests that anthracyclines can be safely omitted in selected patients with HER2-positive breast cancer, who have cT1N0 or cT2N0 and achieved pathological complete response after receiving neoadjuvant chemotherapy.",
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AU - Hayashida, Tetsu

AU - Kawai, Yuko

AU - Kikuchi, Masayuki

AU - Nakashoji, Ayako

AU - Yokoe, Takamichi

AU - Toyota, Tomoka

AU - Seki, Tomoko

AU - Takahashi, Maiko

AU - Kitagawa, Yuukou

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AB - Purpose: In adjuvant settings of human epidermal growth factor receptor 2 (HER2)-positive breast cancer, anthracycline-based chemotherapy followed by taxane and trastuzumab is a standard regimen. Recent studies have reported the use of anthracycline-free adjuvant chemotherapy in selected HER2-positive breast cancer patients. We conducted a single-center retrospective study to identify the characteristics of HER2-positive breast cancer patients for whom anthracyclines can be safely omitted. Methods: A total of 238 women were diagnosed with HER2-positive breast cancer and treated with neoadjuvant and/or adjuvant chemotherapy between January 1, 2008 and December 31, 2015 at Keio University Hospital. They were divided in two cohorts: an “anthracycline” cohort of 112 anthracycline-treated women and a “no anthracycline” cohort of 126 anthracycline-untreated women. Survival outcomes were estimated by Kaplan–Meier method. Results: The 3-year disease-free survival rates in the no-anthracycline and anthracycline cohorts were 91.3% and 93.1%, respectively (P = 0.692). After using a statistical method with inverse probability of treatment weighting to minimize the selection bias, no significant differences were observed between the two cohorts (adjusted hazard ratio for disease-free survival: 1.042; P = 0.909). Stratified by tumor size, no significant differences were observed between the two cohorts in the cT1N0 and cT2N0 subsets (P = 0.516 and P = 0.579, respectively). The recurrence rate was low among patients who achieved pathological complete response after receiving neoadjuvant chemotherapy with or without anthracyclines. Conclusion: Our study suggests that anthracyclines can be safely omitted in selected patients with HER2-positive breast cancer, who have cT1N0 or cT2N0 and achieved pathological complete response after receiving neoadjuvant chemotherapy.

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KW - Pathological complete response

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