A Multi-Centre Randomized Study Comparing Two Standard of Care Chemotherapy Regimens for Lower-Risk HER2-Positive Breast Cancer
, Terry L. Ng 3,4, Mashari Jemaan Alzahrani 3, Jacques Raphael 1,2, Phillip Blanchette 1, Morgan Black 1, Carol Stober 4, Gregory R. Pond 5, David Cella 6, Lisa Vandermeer 4, Mohammed Ibrahim 7 and Mark Clemons 3,4
on behalf of the REaCT Investigators
Round 1
Reviewer 1 Report
The study is an interesting analysis of the feasibility of a large study of a comparison of regimes T-H and TC-H.
The aim of the study was to compare two regimens for lower-risk HER2-positive breast cancer. However, patients with neoadjuvant chemotherapy and N1 were also included in the trial. The criterion of lower-risk HER2-positive breast cancer did not seem to be an inclusion criterion in this trial and therefore should be discussed and/or mentioned in the limitations.
The text contains a few spelling mistakes and some space errors as well as different spellings of HER2.
Author Response
Thanks for the feedback. Please find the answers attached.
Sincerely,
Ricardo Fernandes
Author Response File: 
Author Response.docx
Reviewer 2 Report
This article reviews the role of 2 trastuzumab based regimens in early stage breast cancer and examines the feasibility of conducting a randomised trial in this area where taxol -trastuzumab has become a standard of care with follow up now extending to 10 years.
I found the study confusing - the regimen being studied is considered for <3 cm node negative tumors - in the study node positive and tumors up to 7 cm are included - shouldnt these patients have received pertuzumab based neoadjuvant therapy given that the study was conducted in 2019-21 ?
The widespread global clinical acceptance of the taxane trastuzumab weekly regimen would make the randomised study discussed by the authors extremely difficult to conduct given the greater toxicity of the taxotere cyclophosphamide comparator regimen.
The results are clearly presented by the authors.
The paper would benefit from
1. clearer clarification of the disparate patient population studied - why were high risk patients included in the study of a regimen commonly used as a standard of care in low risk disease
2. clarification of why the study stopped in 2021
3. the high acceptance rate of the proposal by medical oncologists needs elaboration
4. reference 3 and 17 have been updated in the Lancet Oncology, reference 24 needs to be rewritten
Author Response
Thanks for the feedback. Please find the answers attached.
Sincerely,
Ricardo Fernandes
Author Response File: Author Response.docx
