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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ENeoadjuvant treatment regimens resulting in high pathologic complete response (pCR) rates are needed for patients with HER2-positive breast cancer because they are correlated with favorable prognoses. Although N in combination with H is highly effective in HER2-positive breast cancer, this regimen is unsuitable because of high cardiotoxicity. The Phase 2 Study of Neoadjuvant Trastuzumab+Docetaxel+Non-pegylated Liposome-Encapsulated Doxorubicin (NPLD)\u00b1Bevacizumab in HER2-Positive Early Breast Cancer [ABCSG-32; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01367028\u0026amp;atom=%2Fspmdc%2F14%2F36%2F11.2.atom\u0022\u003ENCT01367028\u003C\/a\u003E] was conducted to evaluate the cardiotoxicity and efficacy of N and B in combination with DH in the neoadjuvant treatment of early HER2-positive breast cancer.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EAdjuvant\/Neoadjuvant Therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBreast Cancer\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EAdjuvant\/Neoadjuvant Therapy\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOncology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EBreast Cancer\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EG\u00fcnther Steger, MD, Medical University of Vienna, Vienna, Austria, presented data from a study demonstrating that neoadjuvant docetaxel (D) plus trastuzumab (H), DH plus bevacizumab (B; DHB), DH plus nonpegylated liposomal doxorubicin (N; DHN), and DHNB treatment regimens are feasible and can be safely administered to patients with early HER2-positive breast cancer.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAccording to Prof Steger, neoadjuvant treatment regimens resulting in high pathologic complete response (pCR) rates are needed for patients with HER2-positive breast cancer because they are correlated with favorable prognoses. Although N in combination with H is highly effective in HER2-positive breast cancer, this regimen is unsuitable because of high cardiotoxicity. HER2-positive breast cancer cells have, however, been shown to produce high levels of vascular endothelial growth factor, he added.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EConsequently, the Phase 2 Study of Neoadjuvant Trastuzumab + Docetaxel + Non-pegylated Liposome-Encapsulated Doxorubicin (NPLD) \u00b1 Bevacizumab in HER2-Positive Early Breast Cancer [ABCSG-32; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01367028\u0026amp;atom=%2Fspmdc%2F14%2F36%2F11.2.atom\u0022\u003ENCT01367028\u003C\/a\u003E] was conducted to evaluate the cardiotoxicity and efficacy of N and B in combination with DH in the neoadjuvant treatment of early HER2-positive breast cancer.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EInclusion criteria included patients \u2265 18 years with (1) pathologically confirmed invasive primary breast adenocarcinoma, with or without palpable lymph nodes, who were scheduled for taxane-containing neoadjuvant systemic therapy and (2) HER2 protein overexpression as determined by immunohistochemistry 3 + or by \u003Cem\u003EHER2\u003C\/em\u003E (c-erbB2) gene amplification according to fluorescent in situ hybridization or chromogenic in situ hybridization of the primary tumor. Exclusion criteria included patients with metastatic disease, HER2-negative disease, or a history of prior local or systemic antitumor therapy.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThis open-label phase 2 trial enrolled 100 patients with biopsy-proven, invasive, early HER2-positive breast cancer who were randomized to 6 cycles (every 21 days) of the following:\u003C\/p\u003E\u003Cul class=\u0022list-simple \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n            \u003Cp id=\u0022p-7\u0022\u003E\n               \u003Cem\u003EDH:\u003C\/em\u003E D (100 mg\/m\u003Csup\u003E2\u003C\/sup\u003E) + H (8\/6 mg\/kg; n = 25)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n            \u003Cp id=\u0022p-8\u0022\u003E\n               \u003Cem\u003EDHB:\u003C\/em\u003E DH + B (15 mg\/kg; n = 25)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n            \u003Cp id=\u0022p-9\u0022\u003E\n               \u003Cem\u003EDHN:\u003C\/em\u003E D (75 mg\/m\u003Csup\u003E2\u003C\/sup\u003E) + H + N (50 mg\/m\u003Csup\u003E2\u003C\/sup\u003E; n = 26)\u003C\/p\u003E\n         \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n            \u003Cp id=\u0022p-10\u0022\u003E\n               \u003Cem\u003EDHNB:\u003C\/em\u003E D (75 mg\/m\u003Csup\u003E2\u003C\/sup\u003E) + H + N + B (15 mg\/m\u003Csup\u003E2\u003C\/sup\u003E; n = 24)\u003C\/p\u003E\n         \u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-11\u0022\u003EAll patients received pegfilgrastim (6 mg, subcutaneously) on day 2.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003ECardiotoxicity was low in all 4 regimens, with only 3 cardiac toxicity events documented (DH, n = 0; DHB, DHN, and DHNB, all n = 1). A cardiac toxicity event was defined as the occurrence of symptomatic left ventricular dysfunction, NYHA class 2 to 4; an asymptomatic drop of ejection fraction \u0026gt; 15% from baseline or \u0026lt; 50%; or the appearance of significant arrhythmias requiring treatment.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003EAlthough noncardiac toxicity was also acceptable, it was more pronounced in patients receiving the 3- and 4-drug combinations (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12095\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12095\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12095\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-14\u0022 class=\u0022first-child\u0022\u003ENoncardiac Toxicity of the 4 Neoadjuvant Regimens, No.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-17\u0022\u003EAll 4 regimens were highly effective. The overall pCR rate was 52%, with 63% and 62% of patients experiencing pCR in the DHN and DHNB regimens, respectively. The total pCR rate was also highest after DHN (58%) and DHNB (57%).\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003EProf Steger concluded that neoadjuvant DH, DHB, DHN, and DHNB can be safely administered to patients with HER2-positive early breast cancer. He emphasized, however, that although noncardiac toxicity is acceptable, its increase with the 3- and 4-drug combinations may lead to early treatment termination in some patients.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/36\/11.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzops2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzops2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}