Neoadjuvant Chemotherapy With Trastuzumab With or without Concurrent Radiation Therapy in Human Epidermal Growth...

Area of Science:

• Oncology
• Radiation Oncology
• Medical Oncology

Background:

• Locally advanced breast cancer (LABC) presents unique treatment challenges.
• The role of neoadjuvant concurrent chemoradiation therapy (NACCRT) combined with anti-HER2 therapy in LABC is not well-established.
• HER2-positive LABC requires targeted therapies like trastuzumab.

Purpose of the Study:

• To evaluate the efficacy of NACCRT plus trastuzumab versus standard neoadjuvant chemotherapy (NACT) plus trastuzumab in patients with HER2-positive inoperable LABC.
• To compare pathological complete response (pCR) rates between the two treatment arms.
• To assess secondary endpoints including survival, operability, toxicity, and treatment duration.

Main Methods:

• A phase II randomized trial comparing NACCRT with trastuzumab (Arm B) to NACT with trastuzumab (Arm A) in patients with inoperable HER2-positive LABC.
• Both arms received anthracycline- and taxane-based chemotherapy with trastuzumab.
• Arm B received concurrent radiotherapy (46 Gy) during paclitaxel and trastuzumab, followed by mastectomy; Arm A received sequential radiotherapy (50 Gy).

Main Results:

• No significant difference in pCR rates between Arm A (46.6%) and Arm B (50.9%) (P=0.64).
• Similar 3-year event-free survival (EFS) and overall survival (OS) between the arms.
• NACCRT significantly shortened median treatment duration (193.1 vs 262.9 days; P < 0.0001) and showed comparable surgical wound morbidity.
• Grade 3 radiation dermatitis and neutropenia were observed only in the NACCRT arm; no cardiac toxicity was noted.

Conclusions:

• NACCRT with trastuzumab is a feasible and safe treatment strategy for HER2-positive inoperable LABC.
• This approach significantly reduces overall treatment duration without compromising survival outcomes.
• NACCRT warrants further investigation in select patients prioritizing treatment efficiency.