Treatment given to weaken and destroy breast cancer BEFORE surgery is called neoadjuvant treatment. Neoadjuvant treatment isn’t routinely used on all breast cancers, but may be used if the cancer is large or aggressive. One or more chemotherapy medicines typically are used in a neoadjuvant regimen. The targeted therapies Herceptin (chemical name: trastuzumab), Tykerb (chemical name: lapatinib), and Perjeta (chemical name: pertuzumab) also may be used in a neoadjuvant regimen if the cancer is HER2-positive. HER2-positive breast cancers have too many copies of the HER2/neu gene, which make too much of the HER2 protein. HER2-positive breast cancers tend to be aggressive, so doctors may recommend neoadjuvant treatment for them.
Herceptin can be given at the same time as neoadjuvant chemotherapy (doctors call this concurrent) or after chemotherapy is done (sequential).
A study found that giving the targeted therapy Herceptin at the same time as a chemotherapy regimen that contains an anthracycline before surgery for HER2-positive breast cancer doesn’t offer more benefits than giving Herceptin after chemotherapy and may cause fewer heart problems.
The study was published online on Nov. 13, 2013 by The Lancet Oncology. Read the abstract of “Fluorouracil, epirubicin, and cyclophosphamide (FEC-75) followed by paclitaxel plus trastuzumab versus paclitaxel plus trastuzumab followed by FEC-75 plus trastuzumab as neoadjuvant treatment for patients with HER2-positive breast cancer (Z1041): a randomized, controlled, phase 3 trial.”
Anthracycline chemotherapy medicines are:
- Adriamycin (chemical name: doxorubicin)
- Ellence (chemical name: epirubicin)
- Doxil (chemical name: liposomal doxorubicin)
- daunorubicin (brand names: Cerubidine, DaunoXome)
- mitoxantrone (brand name: Novantrone)
Anthracyclines work by damaging cancer cells’ genes and interfering with their reproduction.
Both Herceptin and the anthracyclines can cause heart problems, including decreased heart function and heart failure. The risk of heart problems can be higher when Herceptin and an anthracycline are used at the same time.
One way doctors judge the effectiveness of neoadjuvant treatment is looking at the tissue removed during surgery to see if any active cancer cells are present. If no active cancer cells are present, doctors call it a "pathologic complete response."
So in this study, the researchers wanted to see if there were differences in the pathologic complete response rates for women who got neoadjuvant Herceptin at the same time as chemotherapy and women who got neoadjuvant Herceptin after chemotherapy.
More than 280 women diagnosed with HER2-positive breast cancer were randomly assigned to get either concurrent or sequential Herceptin and chemotherapy before surgery:
- 140 women got Herceptin after chemotherapy (sequential group)
- 142 women got Herceptin at the same time as chemotherapy (concurrent group)
Pathologic complete response rates were:
- 56.5% in the sequential group
- 54.2% in the concurrent group
The women in the sequential group also were less likely to have heart problems.
In the United States, most doctors give neoadjuvant Herceptin after an anthracycline chemotherapy medicine (sequentially). This study adds more evidence for that regimen’s effectiveness.
If you’ve recently been diagnosed with HER2-positive breast cancer and haven’t had surgery yet, you might want to ask your doctor if neoadjuvant treatment makes sense for you. Together, you and your doctor can decide on the best treatment plan for you and your unique situation.