Chemotherapy Choice in Neoadjuvant Dual Her2 Blockade: Is it Really Essential to Add Anthracycline?

Objectives: Addition of trastuzumab and pertuzumab to neoadjuvant chemotherapy in Human epidermal growth factor receptor 2 (HER-2) positive breast cancer is the current clinical standard. We aimed to determine whether anthra-cycline-containing neoadjuvant chemotherapy yields beneficial effects alongside dual HER-2 blockade, and to assess cardiotoxicity with this treatment. Methods: Fifty-two patients with HER-2-positive breast cancer who received neoadjuvant chemotherapy were retrospectively evaluated at three tertiary health-care centers. The effects of chemotherapy regimen and several other factors such as age, stage, menopause status, lymph node positivity, and hormone receptor positivity on pathological complete response (pCR) were evaluated. Results: The mean age at diagnosis was 46±9 years. The pCR rate was similar between those with and without anthra-cycline-containing regimens (71.4% vs. 70%). Subgroup analyses also showed similar pCR values for those with negative and positive hormone receptors (64.7% vs. 74.3%), those with Ki67 levels <20% and >20% (60% vs. 73.8%), and when premenopausal patients were compared with postmenopausal patients (76.9% vs. 65.4%). Conclusion: It appears that adding anthracycline to dual HER-2 blockade for neoadjuvant therapy did not yield additional benefits in terms of pCR. Further studies are needed to assess anthracycline-containing regimens in patients who will use the neoadjuvant pertuzumab-trastuzumab combination.