Neoadjuvant Trastuzumab and Pertuzumab for Early HER2-Positive Breast Cancer: A Real World Experience.

Background: Randomized studies of neoadjuvant (NA) trastuzumab and pertuzumab combined with chemotherapy for HER2-positive breast cancers (BC) have reported pathological complete response (pCR) rates of 39 to 61%. This study aimed to determine the real-world efficacy and toxicity of NA trastuzumab and pertuzumab combined with chemotherapy in a UK tertiary referral cancer centre. Methods: HER2-positive early BC patients given neoadjuvant chemotherapy with trastuzumab and pertuzumab between October 2016 and February 2018 at our tertiary referral cancer centre were identified via pharmacy records. Clinico-pathological information, treatment regimens, treatment-emergent toxicities, operative details, and pathological responses and outcomes were recorded. Results: 78 female patients were identified; 2 had bilateral diseases and 48 of 78 (62%) were node positive at presentation. 55 of 80 (71%) tumours were ER-positive. PCR occurred in 37 of 78 (46.3%; 95% CI: 35.3-57.2%) patients. 14 of 23 (60.8%) patients with ER-negative tumours achieved pCR; 23 of 55 (41.8%) were ER-positive and 6 of 19 (31.6%) were ER-positive and PgR-positive. No cardiac toxicity was documented. Diarrhoea occurred in 53 of 72 (74%) patients. Grade 3-4 toxicity occurred in ≥2% patients. These were diarrhoea, fatigue, and infection. The Median follow up period was 45.2 months (95% CI 43.8-46.3) with 71 of 78 (91.0%) remaining disease-free and 72 of 78 (92.3%) alive. Estimated OS at 2 years 86% (95% CI: 75-99%). Conclusion: This data confirms the efficacy of neoadjuvant chemotherapy combined with dual HER2 directed therapy. While no cardiac toxicity was observed, diarrhoea occurred frequently. The low pCR rate observed in ER and PgR-positive BCs warrants further investigation and consideration of strategies to increase the pCR rate.

The impact of the introduction of a palliative Macmillan consultant radiographer at one UK cancer centre.

OBJECTIVE: The UK radiotherapy (RT) workforce needs novel strategies to manage increasing demand. The appointment of a palliative RT (PRT) consultant radiographer (CR) offers a potential solution to enhance patient pathways providing timely RT. This article examined the impact of one such appointment. METHODS: Two prospective audits were completed 1 year apart. All patients receiving PRT for bone metastases between 01/01/2014-31/03/2014 (Audit 1) and 01/01/2015-31/01/2015 (Audit 2) were included. Data collected included demographics, treatment site, dose, fractionation, treatment indication and professionals who planned the PRT. The patient pathway from decision to treat (DTT) to commencement of PRT was scrutinized. RESULTS: 97 patients were identified for Audit 1 and 87 patients for Audit 2. Demographics were similar. Figures relate to Audit 1 and in brackets Audit 2. Indications for treatment: pain 55% (61%), metastatic spinal cord compression 41% (38%) and other neurological symptoms 4% (1%). The CR independently planned 13% (60%), being supervised for 36% (3%). Consultant clinical oncologists planned 43% (31%), with 7% (6%) planned by specialist registrars (SpRs). The pathway was enhanced in Audit 2, with 85% of patients treated within 14 days compared with 73% of patients treated in Audit 1. CONCLUSION: A CR has the potential to impact on the patient pathway, enabling quicker times from DTT to treatment. Continued audit of the role is required to ensure that it complements SpR training. ADVANCES IN KNOWLEDGE: Increasing longevity and improved systemic therapies have led to greater numbers of patients living longer with metastatic disease. The appointment of a CR offers a potential solution to the capacity difficulties faced by UK RT services.