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Combination Therapy Effective in Patients With Primary HER2-Negative Breast Cancer

The combination of panitumumab and neoadjuvant chemotherapy for primary human epidermal growth factor receptor 2 (HER2)-negative inflammatory breast cancer had significant efficacy, particularly in patients with triple-negative inflammatory breast cancer, according to a study published in JAMA Oncology (online: June 7, 2018; doi:10.1001/jamaoncol.2018.1436). 

Naoko Matsuda, MD, The University of Texas MD Anderson Cancer Center (Houston, TX), and colleagues evaluated the safety and efficacy of the anti-EGFR antibody panitumumab plus neoadjuvant chemotherapy in patients with primary HER2-negative inflammatory breast cancer.

The study enrolled women with primary HER2-negative inflammatory breast cancer from 2010 to 2015. Patients received 1 dose of panitumumab followed by 4 cycles of panitumumab, nab-paclitaxel, and carboplatin weekly and then 4 cycles of fluorouracil, epirubicin, and cyclophosphamide every three weeks. The median follow-up time was 19.3 months. Tumor tissues collected before and after the first dose of panitumumab were subjected to immunohistochemical staining and RNA sequencing analysis to identify biomarkers predictive of pCR.

Authors of the study noted the primary end point was pCR rate. The secondary end point was safety. The exploratory objective was to identify biomarkers predictive of pCR.

Researchers noted a total of 40 women enrolled in the study with a median age of 57 years. Twenty-nine of the women were post-menopausal. Three patients did not complete therapy because of toxic effects or distant metastasis, 19 patients had triple-negative and 21 had hormone receptor-positive inflammatory breast cancer. 

Researchers reported the pCR and pCR rates were overall, 11 of 40; triple-negative inflammatory breast cancer, 8 of 19; and hormone receptor-positive/HER2-negative inflammatory breast cancer, 3 of 21. During treatment with panitumumab, nab-paclitaxel, and carboplatin, 10 patients were hospitalized for treatment-related toxic effects. There were no treatment related deaths. Several potential predictors of pCR were identified, including pEGFR expression and COX-2 expression. 

“This combination of panitumumab and chemotherapy showed the highest pCR rate ever reported in triple-negative inflammatory breast cancer,” authors concluded. “A randomized phase 2 study is ongoing to determine the role of panitumumab in patients with triple-negative IBC and to further validate predictive biomarkers.”—Janelle Bradley

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