Antitumor activity and efficacy of shorter versus longer duration of anthracycline-taxane neoadjuvant chemotherapy in stage II-III HER2-negative breast cancer: a 10-year, retrospective analysis

Riccardo Lobefaro; Emma Zattarin; Federico Nichetti; Michele Prisciandaro; Francesca Ligorio; Marta Brambilla; Pierangela Sepe; Francesca Corti; Giorgia Peverelli; Arianna Ottini; Teresa Beninato; Laura Mazzeo; Carmen G Rea; Gabriella Mariani; Filippo de Braud; Giulia V Bianchi; Claudio Vernieri; Giuseppe Capri

doi:10.1177/1758835920970081

Antitumor activity and efficacy of shorter versus longer duration of anthracycline-taxane neoadjuvant chemotherapy in stage II-III HER2-negative breast cancer: a 10-year, retrospective analysis

Ther Adv Med Oncol. 2020 Dec 7:12:1758835920970081. doi: 10.1177/1758835920970081. eCollection 2020.

Authors

Riccardo Lobefaro¹, Emma Zattarin¹, Federico Nichetti¹, Michele Prisciandaro¹, Francesca Ligorio¹, Marta Brambilla¹, Pierangela Sepe¹, Francesca Corti¹, Giorgia Peverelli¹, Arianna Ottini¹, Teresa Beninato¹, Laura Mazzeo¹, Carmen G Rea¹, Gabriella Mariani¹, Filippo de Braud¹, Giulia V Bianchi¹, Claudio Vernieri², Giuseppe Capri¹

Affiliations

¹ Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
² Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133, Milan, Italy.

Abstract

Background: Neoadjuvant anthracycline-taxane-based chemotherapy (ChT) is a standard of care treatment option for stage II-III breast cancer (BC) patients. However, the optimal duration of neoadjuvant ChT has been poorly investigated so far.

Material and methods: We retrospectively retrieved clinical data of patients with stage II-III human epidermal growth factor receptor 2-negative (HER2-) BC who were treated between October 2007 and January 2018 with neoadjuvant AT (doxorubicin-paclitaxel) for three cycles followed by CMF (cyclophosphamide-methotrexate-5-fluorouracil) for three cycles (cohort A) or with four AT cycles followed by four CMF cycles (cohort B). The aim of our study was to investigate the impact of neoadjuvant ChT duration (cohort A versus cohort B) on pathological complete response (pCR) rates, disease-free survival (DFS) and overall survival (OS).

Results: Of 209 HER2- BC patients included, 62 had triple-negative breast cancer (TNBC) and 147 had hormone receptor-positive (HR+) BC. Median age was 48 years (range 30-74 years). A total of 111 patients belonged to cohort A and 98 patients belonged to cohort B. pCR was detected in 29 (13.9%) patients, 25 (40.3%) of whom had TNBC and four (2.7%) had HR+ HER2- BC. Patients achieving pCR had significantly longer DFS and OS, with statistical significance reached only in patients with TNBC. We found no differences between cohort A and cohort B in terms of pCR rates (15.3% versus 12.2%; p = 0.55), DFS (p = 0.49) or OS (p = 0.94). The incidence of grade 3/4 adverse events was similar in cohort A versus cohort B as well (22.5% versus 19.4%; p = 0.54).

Conclusion: Shorter duration of neoadjuvant anthracycline-taxane ChT was not associated with worse clinical outcomes in patients with stage II-III BC. Prospective studies are needed to evaluate whether the duration of neoadjuvant anthracycline-taxane-based ChT can be reduced in specific patient subgroups without negatively affecting clinical outcomes.

Keywords: HER2-negative breast cancer; chemotherapy duration; disease-free survival; neoadjuvant chemotherapy; overall survival; pathological complete response; stage II–III breast cancer.