Cardiac safety of neoadjuvant chemotherapy with epirubicin and cyclophosphamide followed by docetaxel/pertuzumab/ trastuzumab for HER2-positive breast cancer patients

Purpose: Early-stage, HER2-positive breast cancer is increasingly treated with neoadjuvant chemotherapy (NAC). After the positive results of the Neosphere trial, the standard of care has been the combination of chemotherapy with two anti-HER2 agents, trastuzumab and pertuzumab. Many oncologists use the sequence of four cycles of anthracyclinecontaining regimen followed by four cycles of taxane with the two monoclonals. We report here the cardiac safety of four cycles of epirubicin with cyclophosphamide followed by four cycles of docetaxel with trastuzumab and pertuzumab, given at the neoadjuvant setting in early, HER2-positive breast cancer. Methods: We retrospectively collected data from the medical records of patients treated at our clinic between 2014 and 2020. Results: It total, 55 patients treated with the same regimen were identified. There were 20 estrogen receptor (ER)-negative and 35 ER-positive patients. Complete pathologic response was observed in 64.8% of the patients. After a median cardiac follow-up of 2.61 years, and a total of 283 echocardiograms, there was only one recorded asymptomatic Left Ventricular Ejection Fraction (LVEF) fall > 25% and no symptomatic left ventricular systolic dysfunction. LVEF consistently dropped during treatment, but the drop was not significant enough to necessitate treatment interruption, and improved during follow-up Conclusion: Our data confirm the effectiveness and cardiac safety of the aforementioned neoadjuvant regimen.

Automated summary

In early HER2-positive breast cancer, neoadjuvant chemotherapy with a combination of epirubicin, cyclophosphamide, docetaxel, trastuzumab, and pertuzumab showed high effectiveness with minimal cardiac side effects. Among 55 patients treated with this regimen, 64.8% achieved complete pathologic response, and only one recorded asymptomatic LVEF fall > 25% during a median 2.61-year cardiac follow-up.