Editor’s note: this article was updated to more accurately distinguish between the treatment groups.

Compared with neoadjuvant trastuzumab emtansine plus pertuzumab, docetaxel plus carboplatin, trastuzumab, and pertuzumab confer a higher pathological complete response (pCR) rate among patients with HER2-positive breast cancer, according to a study published in The Lancet Oncology.1 Docetaxel-containing therapy was, however, associated with a significantly worse toxicity profile.

While neoadjuvant docetaxel-containing therapy yields high 10-year overall survival rates among patients with HER2-positive breast cancer, systemic chemotherapy with docetaxel can lead to serious adverse events (AEs). Trastuzumab emtansine targets HER2-overexpressing cells, possibly mitigating or avoiding docetaxel-associated AEs.

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For the phase 3 KRISTINE trial (ClinicalTrials.gov Identifier: NCT02131064), researchers randomly assigned 444 patients with stage II to III operable cancer to receive neoadjuvant trastuzumab emtansine plus pertuzumab (223 patients) or docetaxel, carboplatin, trastuzumab, and pertuzumab (221 patients).

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pCRs were noted in 44.4% of patients in the trastuzumab emtansine group vs 55.7% of patients in the docetaxel group (P = .016). Superiority was seen regardless of patient age, ECOG status, and ethnicity.

Grade 3 to 4 AEs were, however, much more common in the docetaxel group (64%) than in the trastuzumab emtansine group (13%).

While patients who received docetaxel had faster quality of life deterioration, quality of life was low in both groups by the end of treatment.

The authors concluded that “future efforts should improve the efficacy of chemotherapy without imparting more toxicity. Results from the adjuvant phase of KRISTINE will be reported in the future.”


  1. Hurvitz SA, Martin M, Symmans WF, et al. Neoadjuvant trastuzumab, pertuzumab, and chemotherapy versus trastuzumab emtansine plus pertuzumab in patients with HER2-positive breast cancer (KRISTINE): a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol. 2017 Nov 23. doi: 10.1016/S1470-2045(17)30716-7 [Epub ahead of print]