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

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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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Abbreviations

CI:

Confidence interval

DFS:

Disease-free survival

HER2:

Human epidermal growth factor receptor 2

IPTW:

Inverse probability of treatment weighting

NCCN:

National Comprehensive Cancer Network

OS:

Overall survival

pCR:

Pathological complete response

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Acknowledgements

This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku, Tokyo, 160-8582, Japan

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

Authors
  1. Rurina Watanuki
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  2. Tetsu Hayashida
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  3. Yuko Kawai
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  4. Masayuki Kikuchi
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  5. Ayako Nakashoji
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  6. Takamichi Yokoe
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  7. Tomoka Toyota
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  8. Tomoko Seki
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  9. Maiko Takahashi
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  10. Yuko Kitagawa
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Corresponding author

Correspondence to Tetsu Hayashida.

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Conflict of interest

T. Hayashida received research grants from Chugai, Kyowa Hakko Kirin and Shionogi and lecture fee from Chugai and Pfizer. Y. Kitagawa received research grants from Chugai, Kyowa Hakko Kirin and Shionogi, and lecture fee from Chugai. These are not directly unrelated to this study. All remaining authors have no conflicts of interest to declare.

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Watanuki, R., Hayashida, T., Kawai, Y. et al. Optimal use of anthracycline-free perioperative chemotherapy in HER2-positive breast cancer patients. Int J Clin Oncol 24, 807–814 (2019). https://doi.org/10.1007/s10147-019-01420-2

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  • DOI: https://doi.org/10.1007/s10147-019-01420-2

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