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Leaving out anthracyclines from neoadjuvant chemotherapy made no difference to how many HER2-positive breast cancers disappeared completely when trastuzumab and pertuzumab were given, so the heart-toxic drugs can be dropped.
Phase 3 trial of 438 patients with stage II to III HER2-positive breast cancer randomised to nine cycles of carboplatin-paclitaxel with trastuzumab and pertuzumab, with or without three initial cycles of an anthracycline-containing regimen.
Pathological complete response was 67 percent with anthracyclines and 68 percent without; three-year event-free survival was similar, while febrile neutropenia and cardiac events were more common with anthracyclines.
Anthracycline-free carboplatin-taxane chemotherapy with dual HER2 blockade is a standard neoadjuvant regimen, sparing patients cardiac risk without losing efficacy.