A modified drug combination may lead to a decreased chance of disease recurrence for women with high-risk, human epidermal growth factor receptor 2 (HER2)-negative breast cancer, representing a potential for a shift in treatment protocol for an important subset of patients, according to an editorial published in the Journal of Clinical Oncology.
 
For most women with lymph node positive or high-risk lymph node negative breast cancer, neoadjuvant chemotherapy with solvent-based drug paclitaxel has been the typical standard of care. However, paclitaxel comes with a risk of allergic reactions and nerve damage in some patients. 
 
Previous research reported by the German Breast Group in 2016 showed that substituting albumin-based drug nab-paclitaxel (Abraxane) instead of paclitaxel prior to surgery improved the chances for a complete pathological response at the time of surgery. These initial results suggested a potential role for nab-paclitaxel in early-stage triple negative breast cancer but did not appear to pertain to other disease subtypes, according to the study.
 
In the new findings, patients with triple negative, hormone receptor-positive, and HER-2-positive breast cancers who received nab-paclitaxel instead of standard paclitaxel before surgery experienced improved long-term outcomes.
 
Masey Ross, MD, medical director of the Integrative Health Program and breast medical oncologist at VCU Massey Cancer Center, and Charles Geyer, Jr, MD, associate director for clinical research, Harrigan Haw, Luck Families Chair in Cancer Research and oncologist at Massey, authored an editorial to discuss the implications of the findings.
 
According to the commentary, the study results challenge the assumption that drugs that do not initially improve the chances of having a complete response in the neoadjuvant setting will not still result in better long-term outcomes.
 
Moreover, the authors indicated that the study results may be more applicable to women with hormone receptor-positive, HER-2-negative breast cancer.
 
“We feel it may not be particularly relevant for patients with HER-2 positive breast cancer because substantial improvements in HER-2 directed therapies co-administered with chemotherapy in this subset have occurred since the German study finished accruing patients,” they wrote.
 
Similarly, for triple negative breast cancer, some patients are also treated with carboplatin, which can improve the chances for a complete response when administered before surgery. However, the study did not account for the use of carboplatin and the authors noted that it remains unclear how it may interact with nab-paclitaxel.  
 
Overall, the authors concluded that the robust and clinically meaningful improvements demonstrated in the study may still justify consideration of substitution of nab-paclitaxel for standard paclitaxel as a neoadjuvant therapy for patients with higher-risk HER2-negative breast cancers.
 
“The study is interesting because it makes us rethink whether drugs administered prior to surgery that do not improve chances of having a complete response should be discarded under the assumption that they will not decrease a patient’s risk if recurrence after surgery,” Dr Ross said in the press release.
 
References
 
Ross M, Geyer CE. Nab-paclitaxel: a new standard of care in neoadjuvant therapy of high-risk early breast cancer. Journal of Clinical Oncology. 2019. Doi: 10.1200/JCO.19.00877 
 
Massey oncologists echo findings that suggest a modified drug combination may reduce risk of recurrence for some breast cancer patients [news release]. Massey Cancer Center. https://www.massey.vcu.edu/about/news-center/2019-archive/massey-oncologists-echo-findings-that-suggest-a-modified-drug-combination-may-reduce-risk-of-recurrence-for-some-breast-cancer-patients/. Accessed August 28, 2019.