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Purpose <p>Randomized clinical trials have shown no benefit from adding anthracyclines to neoadjuvant treatment for HER2-positive breast cancer; however, the efficacy in inflammatory breast cancer (IBC) is unknown. Here we compared pathologic response rates for preoperative regimens with or without anthracyclines in HER2-positive primary IBC.</p> Methods <p>We retrospectively reviewed patients diagnosed with HER2-positive primary IBC in 2014–2021 who received neoadjuvant therapy and modified radical mastectomy at MD Anderson Cancer Center, IBC Network institutions and Dana-Farber Cancer Institute. The primary outcome was a pathological complete response (pCR) rate. Secondary outcomes included time to local or regional recurrence (TLRR), event-free survival (EFS), and overall survival (OS). Univariate and multivariable analyses were performed with adjustments for clinically relevant covariates.</p> Results <p>Of the 101 patients included, 39 received docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP), and 62 (docetaxel, trastuzumab, pertuzumab, doxorubicin, and cyclophosphamide) received THP-AC regimen. Median follow-up time was 3.02&#xa0;years. The pCR rates did not differ by regimen type (48.7% TCHP vs. 53.2% THP-AC, <i>p</i> = 0.659). Multivariable logistic regression adjusted for age and estrogen receptor positivity showed no association between pCR or regimen. The multivariable Cox model showed that the patients who received THP-AC had longer TLRR (hazard ratio [HR] 0.279, 95% CI 0.102–0.765, <i>p</i> = 0.0131) and EFS (HR 0.462, 95% CI 0.228–0.936, <i>p</i> = 0.032), with no difference in OS.</p> Conclusion <p>These findings indicate that an anthracycline-containing neoadjuvant regimen is not associated with pCR, but may prolong disease control in patients with HER2-positive IBC. Further investigation of the optimal neoadjuvant regimen for such tumors is warranted.</p>

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Neoadjuvant HER2-targeted regimens with or without anthracyclines for HER2-positive inflammatory breast cancer: a multicenter retrospective study

  • 期刊论文

  • 发表日期：

    2025年8月2日

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  • Toshiaki Iwase,
  • Nithya Sridhar,
  • Megumi Kai,
  • Wenli Dong,
  • Yu Shen,
  • Savitri Krishnamurthy,
  • Anthony Lucci,
  • H. T. Carisa Le-Petross,
  • Azadeh Nasrazadani,
  • Sadia Saleem,
  • Rachel M. Layman,
  • Vincente Valero,
  • Debasish Tripathy,
  • Wendy A. Woodward,
  • Yee Chung Cheng,
  • Faina Nakhlis,
  • Jenifer R. Bellon,
  • Filipa Lynce,
  • Naoto T. Ueno

摘要

Purpose

Randomized clinical trials have shown no benefit from adding anthracyclines to neoadjuvant treatment for HER2-positive breast cancer; however, the efficacy in inflammatory breast cancer (IBC) is unknown. Here we compared pathologic response rates for preoperative regimens with or without anthracyclines in HER2-positive primary IBC.

Methods

We retrospectively reviewed patients diagnosed with HER2-positive primary IBC in 2014–2021 who received neoadjuvant therapy and modified radical mastectomy at MD Anderson Cancer Center, IBC Network institutions and Dana-Farber Cancer Institute. The primary outcome was a pathological complete response (pCR) rate. Secondary outcomes included time to local or regional recurrence (TLRR), event-free survival (EFS), and overall survival (OS). Univariate and multivariable analyses were performed with adjustments for clinically relevant covariates.

Results

Of the 101 patients included, 39 received docetaxel, carboplatin, trastuzumab, and pertuzumab (TCHP), and 62 (docetaxel, trastuzumab, pertuzumab, doxorubicin, and cyclophosphamide) received THP-AC regimen. Median follow-up time was 3.02 years. The pCR rates did not differ by regimen type (48.7% TCHP vs. 53.2% THP-AC, p = 0.659). Multivariable logistic regression adjusted for age and estrogen receptor positivity showed no association between pCR or regimen. The multivariable Cox model showed that the patients who received THP-AC had longer TLRR (hazard ratio [HR] 0.279, 95% CI 0.102–0.765, p = 0.0131) and EFS (HR 0.462, 95% CI 0.228–0.936, p = 0.032), with no difference in OS.

Conclusion

These findings indicate that an anthracycline-containing neoadjuvant regimen is not associated with pCR, but may prolong disease control in patients with HER2-positive IBC. Further investigation of the optimal neoadjuvant regimen for such tumors is warranted.