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Comparison of the efficacy and survival analysis of neoadjuvant chemotherapy for Her-2-positive breast cancer

Authors Li S, Wei W, Jiang Y, Li Q, Huang Q, Yang H, Liu J

Received 19 April 2018

Accepted for publication 14 August 2018

Published 21 September 2018 Volume 2018:12 Pages 3085—3093


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Anastasios Lymperopoulos

Si Li,1,* Wei Wei,1,* Yi Jiang,1 Qiuyun Li,1 Qinghua Huang,1 Huawei Yang,1 Jianlun Liu1,2

1Department of Breast Surgery, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, Guangxi, China; 2Department of General Surgery, Longdong Hospital of Guangxi Medical University, Nanning, Guangxi, China

*These authors contributed equally to this work

Purpose: The objective of this research was to compare the short- and long-term efficacy of the following four neoadjuvant chemotherapy (NAC) regimens: docetaxel/carboplatin/trastuzumab (TCH), docetaxel/epirubicin/cyclophosphamide (TEC), Xeloda/epirubicin/cyclophosphamide followed by Xeloda/docetaxel (XEC-XT), and 5-fluorouracil/epirubicin/cyclophosphamide followed by docetaxel (FEC-T) in human epidermal growth factor receptor-2-positive (Her-2-positive) breast cancer.
Patients and methods: According to treatment preferences, 139 patients with Her-2-positive breast cancer were divided into the following four groups: 39 patients in the TCH group, 35 patients in the TEC group, 33 patients in the XEC-XT group, and 32 patients in the FEC-T group. The primary end points were disease-free survival (DFS) and 5-year overall survival (5-year OS). The secondary end points were the efficacy and toxicity of NAC.
Results: The TCH, TEC, XEC-XT, and FEC-T groups demonstrated overall response rates of 87.1%, 74.3%, 75.8%, and 62.5% (P=0.031), respectively, and pathological complete response rates of 25.6%, 18.2%, 20.0%, and 18.2% (P=0.041), respectively. The DFS rates for the TCH, TEC, XEC-XT, and FEC-T groups were 84.6%, 62.9%, 65.7%, and 46.9% (P=0.01), respectively. The 5-year OS rates for the TCH, TEC, XEC-XT, and FEC-T groups were 87.2%, 69.7%, 71.4%, and 59.4% (P=0.069), respectively. The mean survival time was 59.3 months (TCH group), 53.5 months (TEC group), 55.3 months (XEC-XT group), and 52.4 months (FEC-T group). The difference in survival among the four groups was statistically significant (P=0.04).
Conclusion: In four NAC regimens for the treatment of Her-2-positive breast cancer, the TCH group exhibited better DFS and 5-year OS. The TCH regimen significantly enhanced the pathological complete remission rate of NAC with similar side effects compared to the TEC, XEC-XT, and FEC-T regimens. In terms of long-term efficacy, the XEC-XT treatment was superior to the FEC-T and TEC treatment, and there was no significant difference between the FEC-T and TEC groups.

Keywords: Her-2-positive breast cancer, neoadjuvant chemotherapy, trastuzumab, efficacy, survival analysis, toxic side effects

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