An Audit of Efficacy and Toxicity of Neoadjuvant Paclitaxel and Trastuzumab in HER- 2 Postive Locally Advanced Breast Cancer

Authors

Vinin NV Additional Professor, Department of Radiation Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.
Nabeel Yahiya EK Assistant Professor, Department of Radiation Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.
Joneetha Jones Associate Professor, Department of Radiation Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.
Geetha Muttath Professor, Department of Radiation Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.
Sangeetha Nayanar Professor, Department of Pathology, Malabar Cancer Centre, Thalassery, Kerala, India.
Farhana NP Bsc MRT Intern, Department of Radiation Oncology, Malabar Cancer Centre, Thalassery, Kerala, India.

Keywords:

Her 2 Positive Carcinoma Breast, Neoadjuvant Chemotherapy, Paclitaxel And Trastuzumab,Pathological Complete Response

Abstract

Background: Her 2 positive Carcinoma breast patients are different subgroup of patients, with poorer disease outcome. Locally advanced Breast cancer (LABC) patients are treated with Neoadjuvant chemotherapy (NACT). Hence with this study we intented to know the efficacy of this Neoadjuvant regimen for Her2 positive LABC.

Materials and Methods: This was a retrospective study including Her 2 positive LABC patients who received NACT with weekly Paclitaxel and Trastuzumab.

Results: Median age of the total 105 patients was 50 years. Except one patient, rest all underwent surgery after NACT. Pathological complete response (p CR) was seen in 40 (38 %) patients. Overall survival at 1 year, 2 years, 3 years and 5 years were 96.2%, 91.3%, 86.6% and 81.4% respectively. In p CR group of patients OS at 1 year and 2 years were 100% and 96.3% respectively , did not change at 3 years and 5 years, whereas in partial response patients OS at 1 year, 2 years, 3 years and 5 years were 93.7%, 85.7%, 77.7% and 70% respectively. Overall DFS at 1 year, 2 years, 3years were 87.4%, 84.3% and 82.1 % respectively.DFS in pCR group at 1 year was 92.3% and it was same at 2years and 3 years, while in p PR group at 1year, 2 years and 3 years were 84.1%, 80.9% and 75.3% respectively.

Conclusion: Neoadjuvant weekly Paclitaxel and trastuzumab combination was well tolerated and resulted in excellent pathological response in Her 2 positive LABC with minimal Grade III/ IV toxicities. Overall DFS and OS was good with significantly better, DFS & OS in p CR group of patients compared to others. Hence NACT with Paclitaxel and Trastuzumab is a well tolerated and effective regimen for Her 2 positive LABC patients. This study shows that p CR translates to better DFS and OS.