"A potentially more heart-friendly sequential chemotherapy regimen for breast cancer proved as effective as the standard concurrent approach but with less cardiotoxicity, a randomized trial showed.
Sequential delivery of an anthracycline and trastuzumab (Herceptin) resulted in a pathologic complete response (pCR) rate of 56.5% compared with 54.2% for concurrent administration protocols.
Clinically significant declines in left ventricular ejection fraction occurred infrequently, and the rates did not differ significantly between treatment groups, Aman U. Buzdar, MD, of the University of Texas MD Anderson Cancer Center in Houston, and co-authors reported online in The Lancet Oncology.
"We have shown that anthracycline and taxane neoadjuvant chemotherapy with trastuzumab results in a complete pathological response in many patients with HER2-positive breast cancer," the authors concluded. "Pathological complete responses with concurrent versus sequential administration in combination with [fluorouracil, epirubicin, and cyclophosphamide (FEC)] were similar.
"Thus, concurrent administration of trastuzumab with anthracyclines offers no additional benefit and is not warranted."
In many instances, neoadjuvant chemotherapy for breast cancer can downstage the primary tumor and regional lymph nodes, extending the potential for breast-conserving surgery to more patients. Pathologic CR to neoadjuvant chemotherapy is associated with more favorable outcomes, the authors noted in their introduction."