The Trastuzumab and Vinorelbine Combination: An Alternative to Taxane-Based Chemotherapy for Early-Stage and Locally Advanced HER2-Positive Breast Cancer

Background: Anthracyclines and taxanes have historically constituted the backbone of chemotherapy regimens for patients with breast cancer positive for the human epidermal growth factor receptor 2 (HER2). For a subset of patients who categorically refuse alopecia, or for those with a contraindication to those drugs, there is an urgent need to define alternative regimens. Here, we report our institutional experience with trastuzumab and vinorelbine (TV), a combination with good clinical activity and a good side effect profile for patients with HER2-positive breast cancer. Methods: In a retrospective analysis, outcomes data were extracted for patients receiving TV as their only chemotherapy in the non-metastatic setting at the Jewish General Hospital. For the most part, TV was administered weekly for 6 months, followed by trastuzumab for 6 months. Results: The analysis identified 46 patients (mean age: 64 years) who received TV between 2003 and 2012 (n = 36 adjuvant, n = 10 neoadjuvant). Of the patients in the adjuvant group, 81% had stage i disease. In the neoadjuvant group, 3 patients experienced a complete pathologic response. Only 1 patient experienced local recurrence after a short course (3 months) of adjuvant TV. Overall survival and breast cancer–specific survival were 94% and 98% respectively at a median 5 years of follow-up. Febrile neutropenia–induced sepsis resulted in the death of 1 patient with significant medical comorbidities; 2 other patients died of comorbidities unrelated to their cancer or treatment. Grades 3 or 4 adverse events included neutropenia (23%), febrile neutropenia (10%), fatigue (2%), and anemia (2%). Conclusions: For patients with non-metastatic breast cancer refusing alopecia, or for patients who are not candidates for standard chemotherapy, TV is a reasonable alternative to standard adjuvant chemotherapy.