Kefah Mokbel, Chair of Breast Cancer Surgery at London Breast Institute and Honorary Professor of Medicine at Cardiff University School of Medicine, shared a post on LinkedIn:
“Anthracyclines in HER2+ Breast Cancer: Time to Let Go, Even Without Dual Blockade?
A real-world Chilean cohort of 446 early-stage HER2+ breast cancer patients (2010–2023) adds compelling weight to the anthracycline-free case – and this time it extends beyond dual HER2 blockade.
Key findings:
- Anthracyclines did not significantly improve pCR rates – even in patients receiving trastuzumab alone, without pertuzumab
- pCR with vs without anthracyclines: 63.2% vs 53.7% (pertuzumab group, p=0.372); 50.0% vs 50.3% (trastuzumab-alone group, p=0.975)
- No survival benefit at 47-month median follow-up: iDFS (p=0.19), OS (p=0.96)
- What actually predicted pCR? Tumour biology – higher Ki67, lower ER expression, and greater HER2 amplification/IHC score – not treatment intensification
Why this matters: most de-escalation data (TRAIN-2 and others) comes from settings with dual HER2 blockade. This cohort – from a health system where pertuzumab access is limited in the public sector – shows the anthracycline-free signal holds even with trastuzumab monotherapy. That’s directly relevant for the many healthcare systems worldwide without universal access to dual blockade.
Limitations worth flagging: retrospective, non-randomised treatment allocation, and a small anthracycline-free subgroup (n=82 vs n=364) – so this supports rather than settles the case.
Bottom line: tumour biology, not treatment escalation, appears to be the real driver of response in HER2+ disease. Biomarker-guided de-escalation continues to look feasible and rational – even in resource-limited settings.”
Title: Pathologic complete response and survival in early-stage HER2-positive breast cancer patients treated with or without anthracyclines
Authors: Francisco Acevedo, Benjamín Walbaum, Lidia Medina, Maritza Abud, Roger Gejman, Pablo Zoroquiain, Francisco Domínguez, Mauricio Camus, Catalina Vargas, Marisel Navarro, Constanza Pinto, Catalina Muñoz, Manuel Manzor, César Sánchez
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