Terapia sistémica primaria en cáncer de mama HER2 positivofactores pronósticos y predictores de respuesta, datos de eficacia, cardiotoxicidad y seguimiento a largo plazo

Abstract

Objectives To evaluate the efficacy, cardiotoxicity profile and long-term benefits of neoadjuvant therapy in HER2-positive operable breast cancer patients. Methods A total of 142 patients diagnosed from 2005–2016 were included in the study. The treatment consisted of a sequential regimen of taxanes and anthracyclines plus trastuzumab. The clinical and pathologic responses were evaluated and correlated with clinical and biological factors. The cardiotoxicity profile and long-term benefits were analyzed. Results The median age was 49 years and 4%, 68% and 28% of patients had stage I, II and III breast cancer, respectively, while 10% had inflammatory breast cancer at diagnosis. Hormone receptor (HR) status was negative in 43%, and 62% had grade III breast cancer. The clinical complete response rate, was 49% and 63%, as assessed using ultrasound and MRI, respectively, and this allowed a high rate of conservative surgery (66%). The pathologic complete response (pCR) rate was 51%, and it was higher in HRnegative (64%) than in HR-positive (41%) patients. High HER2/FISH Ratio and high average HER2 copy number were correlated with higher pCR rates. Patients who achieved pCR had longer disease-free survival and a trend towards improved overall survival. A total of 2% of patients showed a 10% decrease in left ventricular ejection fraction to below 50% during treatment. All patients except one recovered after discontinuation of trastuzumab. Conclusion A sequential regimen of taxanes and anthracyclines plus trastuzumab was effective, with high pCR rates and long-term benefit, and a very good cardiotoxicity profile.