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Wei H, Zhang YJ, Yu T, Yan XY, Jiang Q. Methodological quality evaluation of systematic reviews or meta-analysis of trastuzumab-based therapy for breast cancer: A systematic review. Medicine (Baltimore) 2021; 100:e24389. [PMID: 33530234 PMCID: PMC7850684 DOI: 10.1097/md.0000000000024389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/21/2020] [Accepted: 12/29/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To evaluate the methodological quality of systematic reviews (SRs) or meta-analysis of trastuzumab-based therapy for breast cancer. METHODS We searched the PubMed, EMBASE, Web of science, Cochrane library, international prospective register of systematic reviews, Chinese BioMedical Literature Database, Wan Fang, China National Knowledge Infrastructure and VIP database for SRs or meta-analysis. The methodological quality of included literatures was appraised by risk of bias in systematic review (ROBIS) tool. RESULTS Twenty three eligible systematic reviews or meta-analysis were included. Only 2 systematic reviews provided protocol. The most frequently searched databases were PubMed, MEDLINE, EMBASE, and the Cochrane. The two-reviewers model described in the screening for eligible original articles, data extraction, and methodological quality evaluation had 30%, 61%, and 26%, respectively. In methodological quality assessment, 52% SRs or meta-analysis used the Jadad scoring or Cochrane reviewer' handbook. Research question were well matched to all SRs or meta-analysis in phase 1 and 35% of them evaluated "high" risk bias in study eligibility criteria. The "high" risk of bias in all non-Cochrane SRs or meta-analyses, which involve methods used to identify and/or select studies. And more than half SRs or meta-analysis had a high risk of bias in data collection and study appraisal. More than two-third of SRs or meta-analysis were accomplished with high risk of bias in the synthesis and findings. CONCLUSIONS The study indicated poor methodological and reporting quality of SRs/meta-analysis assessing trastuzumab-based therapy for breast cancer. Registration or publishing the protocol and the reporting followed the PRISMA checklist are recommended in future research.
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Affiliation(s)
- Hua Wei
- School of Pharmacy, Chengdu Medical College, Chengdu
- Department of Pharmacy
| | - Yong-Jun Zhang
- Department of Anesthesiology, Dujiangyan People's Hospital, Dujiangyan Medical Center, Dujiangyan
| | - Ting Yu
- Department of Pharmacy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Centre, School of Medicine, University of Electronic Science and Technology of China
| | - Xiao-Yan Yan
- School of Pharmacy, Chengdu Medical College, Chengdu
| | - Qian Jiang
- Department of Pharmacy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Centre, School of Medicine, University of Electronic Science and Technology of China
- Chinese Evidence-Based Medicine Centre, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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2
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Van Leeuwen MT, Luu S, Gurney H, Brown MR, Pearson SA, Webber K, Hunt L, Hong S, Delaney GP, Vajdic CM. Cardiovascular Toxicity of Targeted Therapies for Cancer: An Overview of Systematic Reviews. JNCI Cancer Spectr 2020; 4:pkaa076. [PMID: 33392444 PMCID: PMC7768929 DOI: 10.1093/jncics/pkaa076] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/01/2020] [Accepted: 08/18/2020] [Indexed: 12/16/2022] Open
Abstract
Background Several targeted therapies for cancer have been associated with cardiovascular toxicity. The evidence for this association has not been synthesized systematically nor has the quality of evidence been considered. We synthesized systematic review evidence of cardiovascular toxicity of individual targeted agents. Methods We searched MEDLINE, Embase, and the Cochrane Database of Systematic Reviews for systematic reviews with meta-analyses of cardiovascular outcomes for individual agents published to May 2020. We selected reviews according to prespecified eligibility criteria (International Prospective Register of Systematic Reviews CRD42017080014). We classified evidence of cardiovascular toxicity as sufficient, probable, possible, or indeterminate for specific cardiovascular outcomes based on statistical significance, study quality, and size. Results From 113 systematic reviews, we found at least probable systematic review evidence of cardiovascular toxicity for 18 agents, including high- and all-grade hypertension for bevacizumab, ramucirumab, axitinib, cediranib, pazopanib, sorafenib, sunitinib, vandetanib, aflibercept, abiraterone, and enzalutamide, and all-grade hypertension for nintedanib; high- and all-grade arterial thromboembolism (includes cardiac and/or cerebral events) for bevacizumab and abiraterone, high-grade arterial thromboembolism for trastuzumab, and all-grade arterial thromboembolism for sorafenib and tamoxifen; high- and all-grade venous thromboembolism (VTE) for lenalidomide and thalidomide, high-grade VTE for cetuximab and panitumumab, and all-grade VTE for bevacizumab; high- and all-grade left ventricular ejection fraction decline or congestive heart failure for bevacizumab and trastuzumab, and all-grade left ventricular ejection fraction decline/congestive heart failure for pazopanib and sunitinib; and all-grade corrected QT interval prolongation for vandetanib. Conclusions Our review provides an accessible summary of the cardiovascular toxicity of targeted therapy to assist clinicians and patients when managing cardiovascular health.
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Affiliation(s)
- Marina T Van Leeuwen
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Steven Luu
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Howard Gurney
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Martin R Brown
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Webber
- Department of Oncology, Monash Health, Clayton, Victoria, Australia.,School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Lee Hunt
- Cancer Voices NSW, Milsons Point, New South Wales, Australia
| | - Soojung Hong
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.,Division of Oncology-Haematology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Geoffrey P Delaney
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia.,Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
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3
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Buzatto IPC, Ribeiro-Silva A, Andrade JM, Carrara HHA, Silveira WA, Tiezzi DG. Neoadjuvant chemotherapy with trastuzumab in HER2-positive breast cancer: pathologic complete response rate, predictive and prognostic factors. ACTA ACUST UNITED AC 2017; 50:e5674. [PMID: 28146217 PMCID: PMC5304215 DOI: 10.1590/1414-431x20165674] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/21/2016] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to retrospectively review the pathologic complete response (pCR) rate from patients (n=86) with stage II and III HER2-positive breast cancer treated with neoadjuvant chemotherapy at our institution from 2008 to 2013 and to determine possible predictive and prognostic factors. Immunohistochemistry for hormone receptors and Ki-67 was carried out. Clinical and pathological features were analyzed as predictive factors of response to therapy. For survival analysis, we used Kaplan-Meier curves to estimate 5-year survival rates and the log-rank test to compare the curves. The addition of trastuzumab to neoadjuvant chemotherapy significantly improved pCR rate from 4.8 to 46.8%, regardless of the number of preoperative trastuzumab cycles (P=0.0012). Stage II patients achieved a higher response rate compared to stage III (P=0.03). The disease-free and overall survivals were not significantly different between the group of patients that received trastuzumab in the neoadjuvant setting (56.3 and 70% at 5 years, respectively) and the group that initiated it post-operatively (75.8 and 88.7% at 5 years, respectively). Axillary pCR post neoadjuvant chemotherapy with trastuzumab was associated with reduced risk of recurrence (HR=0.34; P=0.03) and death (HR=0.21; P=0.02). In conclusion, we confirmed that trastuzumab improves pCR rates and verified that this improvement occurs even with less than four cycles of the drug. Hormone receptors and Ki-67 expressions were not predictive of response in this subset of patients. Axillary pCR clearly denotes prognosis after neoadjuvant target therapy and should be considered to be a marker of resistance, providing an opportunity to investigate new strategies for HER2-positive treatment.
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Affiliation(s)
- I P C Buzatto
- Setor de Mastologia, Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A Ribeiro-Silva
- Departamento de Patologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J M Andrade
- Setor de Mastologia, Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - H H A Carrara
- Setor de Mastologia, Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - W A Silveira
- Setor de Mastologia, Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - D G Tiezzi
- Setor de Mastologia, Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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4
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Puppe J, van Ooyen D, Neise J, Thangarajah F, Eichler C, Krämer S, Pfister R, Mallmann P, Wirtz M, Michels G. Evaluation of QTc Interval Prolongation in Breast Cancer Patients after Treatment with Epirubicin, Cyclophosphamide, and Docetaxel and the Influence of Interobserver Variation. Breast Care (Basel) 2017; 12:40-44. [PMID: 28611540 DOI: 10.1159/000455065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Chemotherapy with anthracyclines is associated with life-threatening electrocardiographic alterations including corrected QT (QTc) interval prolongation. PATIENTS AND METHODS In this study we assessed the effect of epirubicin, cyclophosphamide, and docetaxel (EC-Doc) on the QTc interval in 10 patients with early breast cancer. Cardiac toxicity was assessed with symptoms, transthoracic echocardiography, electrocardiography (ECG), and serum cardiac markers at baseline and after 4 cycles of EC and 4 cycles of docetaxel. To evaluate the influence of interobserver variation, the QTc interval was analyzed by a cardiologist, a gynecologist, and with automated ECG interpretation software. RESULTS There was a significant QTc prolongation after EC treatment independent of the investigator. In addition, a significant increase in N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels was noted after EC treatment. QTc prolongation and NT-proBNP levels normalized after docetaxel treatment. Other biochemical markers were within normal ranges. No clinically relevant effect on left ventricular ejection fraction was observed. CONCLUSION This prospective study demonstrated that EC treatment increases the QTc interval and NT-proBNP levels in women with early breast cancer. This effect was reversible and independent of docetaxel administration. Moreover, the treating physician can safely perform QTc interval evaluation as part of clinical routine independent of his/her specialty. Due to the small number of patients, further conclusions are limited at this point.
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Affiliation(s)
- Julian Puppe
- Department of Gynaecology and Obstetrics, University Hospital Cologne, Cologne, Germany.,CIO Center for Integrated Oncology Cologne/Bonn, Bonn, Germany
| | - Deborah van Ooyen
- Department of Gynaecology and Obstetrics, University Hospital Cologne, Cologne, Germany.,CIO Center for Integrated Oncology Cologne/Bonn, Bonn, Germany
| | - Jeanne Neise
- Department of Gynaecology and Obstetrics, University Hospital Cologne, Cologne, Germany.,CIO Center for Integrated Oncology Cologne/Bonn, Bonn, Germany
| | - Fabinshy Thangarajah
- Department of Gynaecology and Obstetrics, University Hospital Cologne, Cologne, Germany.,CIO Center for Integrated Oncology Cologne/Bonn, Bonn, Germany
| | | | - Stefan Krämer
- Department of Gynaecology and Obstetrics, University Hospital Cologne, Cologne, Germany.,CIO Center for Integrated Oncology Cologne/Bonn, Bonn, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Centre of the University of Cologne, Cologne, Germany
| | - Peter Mallmann
- Department of Gynaecology and Obstetrics, University Hospital Cologne, Cologne, Germany.,CIO Center for Integrated Oncology Cologne/Bonn, Bonn, Germany
| | - Marina Wirtz
- Department of Gynaecology and Obstetrics, University Hospital Cologne, Cologne, Germany.,CIO Center for Integrated Oncology Cologne/Bonn, Bonn, Germany
| | - Guido Michels
- Department III of Internal Medicine, Heart Centre of the University of Cologne, Cologne, Germany
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Maximiano S, Magalhães P, Guerreiro MP, Morgado M. Trastuzumab in the Treatment of Breast Cancer. BioDrugs 2016; 30:75-86. [PMID: 26892619 DOI: 10.1007/s40259-016-0162-9] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Breast cancer (BC) is the most common cancer in women worldwide, and has an undeniable negative impact on public health. The advent of molecular biology and immunotherapy has made targeted therapeutic interventions possible, providing treatments tailored to the individual characteristics of the patient and the disease. The over-expression of human epidermal growth factor receptor (HER) 2 is implicated in the pathophysiology of BC and represents a clinically relevant biomarker for its treatment. Trastuzumab, a recombinant antibody targeting HER2, was the first biological drug approved for the treatment of HER2-positive BC. Although there are currently other anti-HER2 agents available (e.g. pertuzumab and lapatinib), trastuzumab remains the gold standard for treatment of this disease subtype. Nonetheless, concerns have been raised regarding potential cardiotoxicity and treatment resistance. Moreover, several other therapeutic issues remain unclear and have been addressed in an inconsistent way. The current literature lacks a comprehensive review of trastuzumab providing useful information for clinical practice, including pharmacokinetic and pharmacodynamic aspects, its clinical use, existing controversies and future advances. This detailed review of trastuzumab in the pharmacotherapy of BC attempts to fill this gap.
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Affiliation(s)
- Sofia Maximiano
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal
| | - Paulo Magalhães
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal.,Laboratory of Pharmacology, Faculty of Pharmacy, University of Coimbra, Pólo das Ciências da Saúde, Azinhaga de Santa Comba, Coimbra, Portugal.,CNC, Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal.,CICAB, Clinical Research Centre, Extremadura University Hospital and Medical School, Badajoz, Spain
| | - Mara Pereira Guerreiro
- Lisbon Nursing School (ESEL), Lisbon, Portugal.,CiiEM, Institute of Health Sciences Egas Moniz (ISCSEM), Monte de Caparica, Portugal
| | - Manuel Morgado
- CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Av. Infante D. Henrique, Covilhã, Portugal. .,Cova da Beira Hospital Centre, E.P.E., Quinta do Alvito, 6200-251, Covilhã, Portugal.
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6
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Labidi S, Mejri N, Lagha A, Daoud N, El Benna H, Afrit M, Boussen H. Targeted Therapies in HER2-Overexpressing Metastatic Breast Cancer. Breast Care (Basel) 2016; 11:418-422. [PMID: 28228709 DOI: 10.1159/000452194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Human epidermal growth factor receptor-2 (HER2) is amplified in 25-30% of breast cancers and is associated with aggressive disease and poorer survival. Multiple anti-HER2 targeted therapies have dramatically changed management and outcome of this subgroup, both in adjuvant and metastatic settings. Despite the improvement of survival thanks to trastuzumab, unclear mechanisms of resistance occur, which has led to the development of new anti-HER2 therapies such as lapatinib, pertuzumab, and trastuzumab emtansine (T-DM1). The optimal sequence of the available drugs is still not well established. All this progress raises the question of toxicity that need to be managed, especially with longer survival of patients. In this article, we review different anti-HER2 therapies used in HER2-positive m etastatic breast cancer.
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Affiliation(s)
- Soumaya Labidi
- Medical oncology department, Abderrahmane Mami Hospital, University of medicine Tunis-University El Manar, Ariana, Tunisia
| | - Nesrine Mejri
- Medical oncology department, Abderrahmane Mami Hospital, University of medicine Tunis-University El Manar, Ariana, Tunisia
| | - Aymen Lagha
- Medical oncology department, Abderrahmane Mami Hospital, University of medicine Tunis-University El Manar, Ariana, Tunisia
| | - Nouha Daoud
- Medical oncology department, Abderrahmane Mami Hospital, University of medicine Tunis-University El Manar, Ariana, Tunisia
| | - Houda El Benna
- Medical oncology department, Abderrahmane Mami Hospital, University of medicine Tunis-University El Manar, Ariana, Tunisia
| | - Mehdi Afrit
- Medical oncology department, Abderrahmane Mami Hospital, University of medicine Tunis-University El Manar, Ariana, Tunisia
| | - Hamouda Boussen
- Medical oncology department, Abderrahmane Mami Hospital, University of medicine Tunis-University El Manar, Ariana, Tunisia
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7
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Defining the optimal sequence for the systemic treatment of metastatic breast cancer. Clin Transl Oncol 2016; 19:149-161. [PMID: 27314861 PMCID: PMC5239809 DOI: 10.1007/s12094-016-1520-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 05/19/2016] [Indexed: 12/17/2022]
Abstract
Metastatic breast cancer is a heterogeneous disease that presents in varying forms, and a growing number of therapeutic options makes it difficult to determine the best choice in each particular situation. When selecting a systemic treatment, it is important to consider the medication administered in the previous stages, such as acquired resistance, type of progression, time to relapse, tumor aggressiveness, age, comorbidities, pre- and post-menopausal status, and patient preferences. Moreover, tumor genomic signatures can identify different subtypes, which can be used to create patient profiles and design specific therapies. However, there is no consensus regarding the best treatment sequence for each subgroup of patients. During the SABCC Congress of 2014, specialized breast cancer oncologists from referral hospitals in Europe met to define patient profiles and to determine specific treatment sequences for each one. Conclusions were then debated in a final meeting in which a relative degree of consensus for each treatment sequence was established. Four patient profiles were defined according to established breast cancer phenotypes: pre-menopausal patients with luminal subtype, post-menopausal patients with luminal subtype, patients with triple-negative subtype, and patients with HER2-positive subtype. A treatment sequence was then defined, consisting of hormonal therapy with tamoxifen, aromatase inhibitors, fulvestrant, and mTOR inhibitors for pre- and post-menopausal patien ts; a chemotherapy sequence for the first, second, and further lines for luminal and triple-negative patients; and an optimal sequence for treatment with new antiHER2 therapies. Finally, a document detailing all treatment sequences, that had the agreement of all the oncologists, was drawn up as a guideline and advocacy tool for professionals treating patients with this disease.
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8
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Pizzuti L, Barba M, Giannarelli D, Sergi D, Botti C, Marchetti P, Anzà M, Maugeri-Saccà M, Natoli C, Di Filippo S, Catenaro T, Tomao F, Amodio A, Carpano S, Perracchio L, Mottolese M, Di Lauro L, Sanguineti G, Di Benedetto A, Giordano A, Vici P. Neoadjuvant Sequential Docetaxel Followed by High-Dose Epirubicin in Combination With Cyclophosphamide Administered Concurrently With Trastuzumab. The DECT Trial. J Cell Physiol 2016; 231:2541-7. [PMID: 27187274 PMCID: PMC5089631 DOI: 10.1002/jcp.25432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 01/02/2023]
Abstract
To report the results of the DECT trial, a phase II study of locally advanced or operable HER2-positive breast cancer (BC) treated with taxanes and concurrent anthracyclines and trastuzumab. Eligible patients (stage IIA-IIIB HER2-positive BC, 18-75 years, normal organ functions, ECOG ≤1, and left ventricular ejection fraction (LVEF) ≥55%) received four cycles of neoadjuvant docetaxel, 100 mg/m(2) intravenously, plus trastuzumab 6 mg/kg (loading dose 8 mg/kg) every 3 weeks, followed by four 3-weekly cycles of epirubicin 120 mg/m(2) and cyclophosphamide, 600 mg/m(2) , plus trastuzumab. Primary objective was pathologic complete response (pCR) rate, defined as ypT0/is ypN0 at definitive surgery. We enrolled 45 consecutive patients. All but six patients (13.3%) completed chemotherapy and all underwent surgery. pCR was observed in 28 patients (62.2%) overall and in 6 (66.7%) from the inflammatory subgroup. The classification and regression tree analysis showed a 100% pCR rate in patients with BMI ≥25 and with hormone negative disease. The median follow up was 46 months (8-78). Four-year recurrence-free survival was 74.7% (95%CI, 58.2-91.2). Seven patients (15.6%) recurred and one died. Treatment was well tolerated, with limiting toxicity being neutropenia. No clinical cardiotoxicity was observed. Six patients (13.4%) showed a transient LVEF decrease (<10%). In one patient we observed a ≥10% asymptomatic LVEF decrease persisting after surgery. Notwithstanding their limited applicability due to the current guidelines, our findings support the efficacy of the regimen of interest in the neoadjuvant setting along with a fairly acceptable toxicity profile, including cardiotoxicity. Results on BMI may invite further assessment in future studies. J. Cell. Physiol. 231: 2541-2547, 2016. © 2016 The Authors. Journal of Cellular Physiology Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Laura Pizzuti
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.,Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Diana Giannarelli
- Biostatistics Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Domenico Sergi
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Department of Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Marchetti
- Oncology Unit, Sant'Andrea Hospital, La Sapienza University of Rome, Rome, Italy
| | - Michele Anzà
- Department of Surgery, Regina Elena National Cancer Institute, Rome, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy.,Scientific Direction, Regina Elena National Cancer Institute, Rome, Italy
| | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences and CeSI-MeT, G. d'Annunzio University, Chieti, Italy
| | | | - Teresa Catenaro
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Federica Tomao
- Department of Gynecologic Oncology, University "Sapienza", Rome, Italy
| | - Antonella Amodio
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Silvia Carpano
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Letizia Perracchio
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Marcella Mottolese
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Luigi Di Lauro
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Anna Di Benedetto
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine and Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania
| | - Patrizia Vici
- Division of Medical Oncology 2, Regina Elena National Cancer Institute, Rome, Italy
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