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Adjuvant therapy for HER2+ breast cancer: practice, perception, and toxicity

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Abstract

Multiple adjuvant regimens are used for HER2+ breast cancer, but experience in routine practice is not reported. We evaluated whether oncologists’ perceptions of these regimens matches clinical experience. We surveyed Wisconsin medical oncologists throughout the state regarding factors impacting selection of TCH (docetaxel, carboplatin, and trastuzumab) or anthracycline-based therapy. We also reviewed 200 cases of HER2+ breast cancer treated at the University of Wisconsin and the Marshfield Clinic and collected data on patient and tumor characteristics, chemotherapy regimen, and toxicities. Two-thirds of surveyed oncologists prefer anthracycline-based therapy, particularly for node-positive cancers. However, TCH was preferred for early-stage (T1a-bN0) tumors. Half of oncologists use prophylactic G-CSF with TCH. In the 200 cases reviewed at our centers, acute toxicity occurred more frequently with TCH. There were fewer dose modifications or delays for AC-TH (doxorubicin, cyclophosphamide, paclitaxel, and trastuzumab) than TCH (31% vs. 47%, P = 0.07), possibly due to higher use of prophylactic G-CSF with AC-TH (77% vs. 34% with TCH, P < 0.001). Fifteen patients received prophylactic G-CSF during TCH; none developed neutropenic fever. In contrast, 25% developed neutropenic fever during TCH without G-CSF. There were modest declines in median left ventricular ejection fraction reaching 9% with AC-TH and 3% with TCH at 12 months, but early cessation of trastuzumab was similar for both regimens. We conclude that TCH and AC-TH are common adjuvant regimens used for HER2+ breast cancer. The preference of TCH for early-stage disease and anthracycline-based therapy for node-positive disease suggests that many oncologists perceive that TCH is safer and AC-TH more effective. Myelosuppression from TCH is greater than AC-TH, but can be mitigated with routine G-CSF.

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Abbreviations

G-CSF:

Granulocyte-colony stimulating factor, filgrastim, or peg-filgrastim

HER2:

Human epidermal growth factor receptor 2

LVEF:

Left ventricular ejection fraction

ER:

Estrogen receptor

PR:

Progesterone receptor

TCH:

Docetaxel, cyclophosphamide, trastuzumab

AC-TH:

Doxorubicin, cyclophosphamide followed by paclitaxel and trastuzumab

AC-DH:

Doxorubicin, cyclophosphamide followed by docetaxel and trastuzumab

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Acknowledgments

We thank T. Champeny (UWCCC Breast DOWG), R. Millholland (UW Tumor Registry), N. Jones, X. Zhang, and A. Trentham-Dietz (UW Shared Survey Service), A. Traynor, M.B. Wims and the Wisconsin Oncology Network physicians. This study was supported by UW Carbone Cancer Center P30 CA14520. M. Burkard is supported by CTSA 1UL1RR025011 and Flight Attendant Medical Research Institute (FAMRI).

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Authors and Affiliations

  1. University of Wisconsin Carbone Cancer Center, Wisconsin Institutes for Medical Research, 6th floor, 1111 Highland Avenue, Madison, WI, USA

    Gabrielle Rocque, KyungMann Kim, Kari B. Wisinski, Amye Tevaarwerk & Mark E. Burkard

  2. Department of Medicine, Hematology and Medical Oncology Division, University of Wisconsin, Madison, WI, USA

    Gabrielle Rocque, Kari B. Wisinski, Amye Tevaarwerk & Mark E. Burkard

  3. Department of Hematology/Oncology, Marshfield Clinic, Weston, WI, USA

    Adedayo Onitilo & Jessica Engel

  4. Marshfield Clinic Research Foundation, Weston, WI, USA

    Adedayo Onitilo, Jessica Engel, Shailly Rishi & Bonnie Waack

  5. University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Erica Pettke & Alice Boshoven

  6. Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA

    KyungMann Kim

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  1. Gabrielle Rocque
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  2. Adedayo Onitilo
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Correspondence to Mark E. Burkard.

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Appendix: Physician Survey Document (DOC 32 kb)

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Rocque, G., Onitilo, A., Engel, J. et al. Adjuvant therapy for HER2+ breast cancer: practice, perception, and toxicity. Breast Cancer Res Treat 131, 713–721 (2012). https://doi.org/10.1007/s10549-011-1862-y

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  • DOI: https://doi.org/10.1007/s10549-011-1862-y

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