TRAIN-2 questions neoadjuvant anthracycline use for HER2-positive breast cancer
medwireNews: Carboplatin plus taxane neoadjuvant chemotherapy may be sufficient for women undergoing dual HER2 blockade for stage II–III HER2-positive breast cancer, findings from the TRAIN-2 study suggest.
“In view of the high proportion of pathological complete responses recorded in both groups and the fact that febrile neutropenia was more frequent in the anthracycline group, omitting anthracyclines from neoadjuvant treatment regimens might be a preferred approach”, say Gabe Sonke, from the Netherlands Cancer Institute in Amsterdam, and co-investigators.
All the trial participants received trastuzumab 6 mg/kg plus pertuzumab 420 mg on day 1 of each 3-week cycle, they explain in The Lancet Oncology.
A pathological complete response (pCR) was achieved in 67% of the 212 patients randomly assigned to receive three cycles of 5-fluorouracil, epirubicin and cyclophosphamide, followed by paclitaxel on days 1 and 8, and carboplatin given either on day 1 or days 1 and 8 according to physician preference.
The 206 patients who were randomly assigned to receive only paclitaxel plus carboplatin and no anthracycline therapy achieved a similar pCR of 68%.
Overall, serious adverse events occurred in 28% of the anthracycline arm and 22% of the non-anthracycline arm. The two groups had comparable rates of the most common side effects including grade 3 or more severe neutropenia (60 vs 54%) and diarrhoea (12 vs 18%), and grade 2 or worse peripheral neuropathy (30 vs 31%).
But the anthracycline regimen was associated with a significantly higher rate of febrile neutropenia (11 vs 1%) and one patient given the anthracycline regimen died from pulmonary embolism possibly related to treatment.
“Further follow-up and the overall survival data are needed to confirm the observed similar efficacy of both regimens used in this study”, the researchers write.
They mention the upcoming TRAIN-3 study investigating tailored use of neoadjuvant chemotherapy based on radiological response in HER2-positive breast cancer patients.
“In this future study, we hypothesise that the long-term event-free and overall survival of patients in complete remission after three cycles of chemotherapy will be similar to that in patients who achieve a complete remission after six or nine cycles”, they write.
“If our hypothesis is verified, the findings of the study will hopefully support a treatment approach in which patients with an early complete radiological remission can be referred for early surgery.”
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