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Retrospective study of the efficacy and safety of neoadjuvant docetaxel, carboplatin, trastuzumab/pertuzumab (TCH-P) in nonmetastatic HER2-positive breast cancer

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Abstract

Background

Pertuzumab is FDA approved in the preoperative setting in combination with trastuzumab and chemotherapy, in women with nonmetastatic HER2 + breast cancer. The TRYPHAENA trial (n = 77) reported a pathologic complete response rate (pCR), i.e., ypT0ypN0, of 52 % in patients treated with neoadjuvant (docetaxel, carboplatin, trastuzumab, & pertuzumab) TCH-P. Aside from this study, there is limited information regarding the safety and efficacy of TCH-P in the neoadjuvant setting. Our goal was to evaluate the safety and efficacy of neoadjuvant TCH-P in a non-clinical trial setting.

Materials and methods

Cancer data registry was utilized to identify patients with HER2 + nonmetastatic breast cancer that received neoadjuvant TCH-P. pCR was defined as the absence of invasive or noninvasive cancer in breast and lymph nodes, i.e., ypT0ypN0.

Results

70 patients with a median age of 52 years met our inclusion criteria. Clinical staging was I-8.5 %; II-68.5 %; and III-22.8 %. 60 % of patients had hormone receptor (HR)-positive tumors. 23 % (16/71) of patients required dose reduction for rash, diarrhea, neuropathy, or thrombocytopenia. Overall, no patients developed grade 3–4 left ventricular systolic dysfunction(LVSD); an asymptomatic reduction in LVEF of >10 % was observed in three patients. The overall observed pCR rate was 53 %. As expected, the pCR rate was higher in patients with HR-negative breast cancer than for patients with HR+ disease: 69 % (20/29) vs. 42 % (17/41), respectively. The axillary downstaging rate was approximately 53 % (19/36).

Conclusion

Neoadjuvant TCH-P, in a nonclinical trial setting, was associated with a pCR rate of 53 % similar the reported rate in TRYPHAENA. Toxicity was manageable, with no patients experiencing symptomatic heart failure.

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Authors and Affiliations

  1. Department of Hematology Oncology, Cleveland Clinic Taussig Cancer Institute, Mail Code R35, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Shruti R. Tiwari, Paola Raska, Jame Abraham, Halle Moore, G. Thomas Budd & Alberto J. Montero

  2. Department of Medicine, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Prasun Mishra

  3. Department of Anatomic Pathology, Cleveland Clinic Main Campus, Mail Code L25, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Benjamin Calhoun

  4. Department of General Surgery/Breast Services, Cleveland Clinic Main Campus, Mail Code A81, 9500 Euclid Avenue, Cleveland, OH, 44195, USA

    Alicia Fanning, Stephanie Valente, Robyn Stewart & Stephen R. Grobmyer

Authors
  1. Shruti R. Tiwari
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  2. Prasun Mishra
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  3. Paola Raska
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Corresponding author

Correspondence to Alberto J. Montero.

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Conflict of interest

The authors declare there is no conflict of interest in the writing, preparing, or finalizing of this manuscript. All authors have no disclosures other than GT Budd who has research funding from Genentech/Roche.

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Tiwari, S.R., Mishra, P., Raska, P. et al. Retrospective study of the efficacy and safety of neoadjuvant docetaxel, carboplatin, trastuzumab/pertuzumab (TCH-P) in nonmetastatic HER2-positive breast cancer. Breast Cancer Res Treat 158, 189–193 (2016). https://doi.org/10.1007/s10549-016-3866-0

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  • DOI: https://doi.org/10.1007/s10549-016-3866-0

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