Speak of the devil.
The Study: So it’s a shame half the preferred systemic regimens for HER2(+) breast cancer in the NCCN guidelines include an anthracycline, particularly considering its inclusion may mean double or triple the cardiotoxic meds.The Dutch phase 3 TRAIN-2 trial aimed to remove anthracyclines from the equation. It randomized over 400 women with stage I-II HER2(+) breast cancer to receive upfront  ECF q3 weeks x 3 → carbo/Taxol q3 weeks x 6 versus  straight-up carbo/Taxol q3 weeks x 9. Everyone also received trastuzumab + pertuzumab q3 weeks throughout their neoadjuvant regimens and adjuvant trastuzumab to complete one year. The primary endpoint of pathologic complete responses in breast and axilla were astonishingly high at 67% with epirubicin and 68% without. Surprisingly overall toxicities weren’t very different, except febrile neutropenia that was much higher with epirubicin (10%) than without (1%).
Bottom Line: In the era of dual HER2-blockade, even women with locally-advanced HER2(+) breast cancer are likely just as well off going anthracycline-free. | van Ramshorst, Lancet Oncol 2018