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

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.

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.

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.

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.