Ades, Moraes F

Ahmed, R

Asher, R

Beresford, M

De, Azambuja E

Gojis, O

Howell, SJ

Januszewski, A

Lewanski, C

Lythgoe, D

Macpherson, IRJ

Owadally, W

Palmieri, C

Riddle, P

Shah, D

Stanley, B

Yan, K

Background:Neoadjuvant chemotherapy delivered with trastuzumab (NCT) has been shown to increase the rates of pathological complete response (pCR) compared to neoadjuvant chemotherapy (NC) alone in women with HER2 positive breast cancer (BC). pCR in this setting has been associated with improved event free survival (EFS). However, no study has yet investigated the effect on outcomes of NCT compared to NC followed by adjuvant trastuzumab initiated postoperatively (NCAT). This study sought to investigate the impact on breast cancer outcomes of concomitant (NCT) versus sequential (NCAT) treatment in HER2 positive early breast cancer.Methods:Women with HER2 positive invasive breast cancers treated with neoadjuvant chemotherapy between 2006-2010 were identified at each of 7 European institutions and the case notes reviewed. Preoperative clinical, radiological and pathological details, treatment details and pathology results following breast surgery were reviewed. To be defined as NCT at least one dose of trastuzumab needed to be given preoperatively. pCR was defined as absence of invasive disease in breast and lymph nodes. Multivariable Cox regression and logistic regression were used to Survival outcomes for event-free survival (EFS) were calculated by log rank analysis model the influence of a number of factors on event-free survival (EFS) and pCR respectively.Results:236 patients were identified; 138 (58%) received NCAT &amp; 98 (42%) received NCT. The median follow up for the whole group was 53.7 months (IQR 41.7-68.8), 61.5 months (IQR 50.3-78.5) for NCAT group and 44.8 months (range 37-53.9) for NCT group. The 5-year EFS for NCAT vs NCT was 59.3% (95% CI: 49.8-67.6) and 69.6% (95% CI: 51.5-82.0) respectively. The unadjusted hazard ratio (HR) for EFS with NCT compared with the NCAT was 0.63 (95% CI 0.37–1.08; p=0.091). NCT significantly increased the odds of having pCR relative to NC (OR: 4.39 (2.18-8.86); 

The University of Manchester - Institutional Repository

Effects on outcome of concomitant neoadjuvant chemotherapy-trastuzumab compared with sequential neoadjuvant chemotherapy followed by post-operative trastuzumab

Effects on outcome of concomitant neoadjuvant chemotherapy-trastuzumab compared with sequential neoadjuvant chemotherapy followed by post-operative trastuzumab

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