Desenlaces oncológicos y seguridad del tratamiento neoadyuvante con y sin antraciclinas en cáncer de mama temprano y localmente avanzado HER-2 positivo en el Instituto Nacional de Cancerología

Introducción: Ensayos clínicos recientes han mostrado efectividad similar entre los esquemas con y sin antraciclinas en neoadyuvancia de cáncer de mama temprano y localmente avanzado respecto a tasas de respuesta patológica completa (RPC) y supervivencia libre de evento, lo cual ha motivado una tend...

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Autores:
Acevedo Ramos, Alfredo José
Zuluaga Liberato, Andrea Marcela
Tipo de recurso:
https://purl.org/coar/resource_type/c_7a1f
Fecha de publicación:
2025
Institución:
Universidad El Bosque
Repositorio:
Repositorio U. El Bosque
Idioma:
spa
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oai:repositorio.unbosque.edu.co:20.500.12495/15562
Acceso en línea:
https://hdl.handle.net/20.500.12495/15562
Palabra clave:
Cáncer de mama
HER2 positivo
Neoadyuvancia
Antraciclinas
Respuesta patológica completa
Breast cancer
HER2 positive
Neoadjuvant
Anthracyclines
Pathological complete response
QZ 200
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License
Attribution-NonCommercial-ShareAlike 4.0 International
id UNBOSQUE2_e46f8388c667aff7470f58faf7a9b41f
oai_identifier_str oai:repositorio.unbosque.edu.co:20.500.12495/15562
network_acronym_str UNBOSQUE2
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repository_id_str
dc.title.none.fl_str_mv Desenlaces oncológicos y seguridad del tratamiento neoadyuvante con y sin antraciclinas en cáncer de mama temprano y localmente avanzado HER-2 positivo en el Instituto Nacional de Cancerología
dc.title.translated.none.fl_str_mv Oncologic Outcomes and Safety of Neoadjuvant Treatment with Anthracyclines Versus Anthracycline-free Regimens in HER2-Positive Early Breast Cancer in a National Cancer Institute
title Desenlaces oncológicos y seguridad del tratamiento neoadyuvante con y sin antraciclinas en cáncer de mama temprano y localmente avanzado HER-2 positivo en el Instituto Nacional de Cancerología
spellingShingle Desenlaces oncológicos y seguridad del tratamiento neoadyuvante con y sin antraciclinas en cáncer de mama temprano y localmente avanzado HER-2 positivo en el Instituto Nacional de Cancerología
Cáncer de mama
HER2 positivo
Neoadyuvancia
Antraciclinas
Respuesta patológica completa
Breast cancer
HER2 positive
Neoadjuvant
Anthracyclines
Pathological complete response
QZ 200
title_short Desenlaces oncológicos y seguridad del tratamiento neoadyuvante con y sin antraciclinas en cáncer de mama temprano y localmente avanzado HER-2 positivo en el Instituto Nacional de Cancerología
title_full Desenlaces oncológicos y seguridad del tratamiento neoadyuvante con y sin antraciclinas en cáncer de mama temprano y localmente avanzado HER-2 positivo en el Instituto Nacional de Cancerología
title_fullStr Desenlaces oncológicos y seguridad del tratamiento neoadyuvante con y sin antraciclinas en cáncer de mama temprano y localmente avanzado HER-2 positivo en el Instituto Nacional de Cancerología
title_full_unstemmed Desenlaces oncológicos y seguridad del tratamiento neoadyuvante con y sin antraciclinas en cáncer de mama temprano y localmente avanzado HER-2 positivo en el Instituto Nacional de Cancerología
title_sort Desenlaces oncológicos y seguridad del tratamiento neoadyuvante con y sin antraciclinas en cáncer de mama temprano y localmente avanzado HER-2 positivo en el Instituto Nacional de Cancerología
dc.creator.fl_str_mv Acevedo Ramos, Alfredo José
Zuluaga Liberato, Andrea Marcela
dc.contributor.advisor.none.fl_str_mv Prieto Garzón, Lina María
dc.contributor.author.none.fl_str_mv Acevedo Ramos, Alfredo José
Zuluaga Liberato, Andrea Marcela
dc.contributor.orcid.none.fl_str_mv Acevedo Ramos, Alfredo José [0009-0009-8660-9848]
Zuluaga Liberato, Andrea Marcela [0000-0002-0410-9527]
dc.subject.none.fl_str_mv Cáncer de mama
HER2 positivo
Neoadyuvancia
Antraciclinas
Respuesta patológica completa
topic Cáncer de mama
HER2 positivo
Neoadyuvancia
Antraciclinas
Respuesta patológica completa
Breast cancer
HER2 positive
Neoadjuvant
Anthracyclines
Pathological complete response
QZ 200
dc.subject.keywords.none.fl_str_mv Breast cancer
HER2 positive
Neoadjuvant
Anthracyclines
Pathological complete response
dc.subject.nlm.none.fl_str_mv QZ 200
description Introducción: Ensayos clínicos recientes han mostrado efectividad similar entre los esquemas con y sin antraciclinas en neoadyuvancia de cáncer de mama temprano y localmente avanzado respecto a tasas de respuesta patológica completa (RPC) y supervivencia libre de evento, lo cual ha motivado una tendencia al retiro progresivo del uso de las antraciclinas en este escenario clínico, buscando disminuir efectos adversos como cardiotoxicidad y mielotoxicidad. Sin embargo, no hay estudios comparativos entre los dos esquemas más usados actualmente, derivados de los estudios BERENICE y TRAIN-2. Métodos: Se realizó un estudio observacional retrospectivo analítico con pacientes con diagnóstico de cáncer de mama HER-2 positivo temprano y localmente avanzado que iniciaron quimioterapia neoadyuvante con antraciclina (Doxorrubicina, Ciclofosfamida x 4, Taxano, Trastuzumab y Pertuzumab x 4 = AC-THP) y sin antraciclinas (Carboplatino, Paclitaxel semanal, Trastuzumab y Pertuzumab por 6-9 ciclos = TCbHP) tratados en el Instituto Nacional de Cancerología entre abril 2020 y diciembre 2024. Se evaluó en el análisis inicial respuesta patológica completa, así como toxicidad cardiaca y neurotoxicidad en ambos brazos de tratamiento. Resultados: Se incluyeron 111 pacientes en los que se definió tratamiento neoadyuvante con quimioterapia más Pertuzumab y Trastuzumab. 51 pacientes recibieron AC-THP y 60 TCbHP (89.6% recibieron 6 ciclos). No hubo diferencia estadísticamente significativa en la RPC entre los pacientes operados de cada brazo. 58.3% ACHTP y 60.4% en TCbHP (OR 1.08 IC 95% 0.49-2.36 p = 0.84). Como análisis descriptivo hubo una tendencia a mayor RPC en pacientes Tamaño tumoral T3-T4, (Compromiso ganglionar) N+ y Receptores hormonales (RH) positivos en pacientes que recibieron el brazo de antraciclinas. Los eventos de descenso de FEVI >10% con valor absolutos <50% durante la fase de neoadyuvancia fue de 9.8 y 3.3% en ACTHP vs TCbHP. Los eventos de neuropatía grado 2 se registraron en 9.8% vs 23.3% de los pacientes que recibieron TCbHP, respectivamente. Conclusiones: A pesar de usar menos ciclos que los administrados en el estudio TRAIN-2 (6 vs 9 ciclos) en la mayoría de los pacientes, encontramos tasas de RPC similares entre el esquema sin antraciclinas vs con antraciclinas. Quizás, aun es pertinente discutir el riesgo beneficio de usar esquema con antraciclinas en pacientes con RH+, T3-4 y N+ además de las consideraciones habituales de los antecedentes de factores de riesgo cardiovascular. Los eventos de cardiotoxicidad del brazo de antraciclinas fueron similares al estudio BERENICE. Por su parte registramos menos casos de neuropatía grado 2 o más que en el estudio TRAIN-2 posiblemente por el número reducido de ciclos recibidos.
publishDate 2025
dc.date.accessioned.none.fl_str_mv 2025-07-29T17:54:04Z
dc.date.available.none.fl_str_mv 2025-07-29T17:54:04Z
dc.date.issued.none.fl_str_mv 2025-06
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.local.spa.fl_str_mv Tesis/Trabajo de grado - Monografía - Especialización
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dc.type.driver.none.fl_str_mv info:eu-repo/semantics/bachelorThesis
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dc.identifier.uri.none.fl_str_mv https://hdl.handle.net/20.500.12495/15562
dc.identifier.instname.spa.fl_str_mv instname:Universidad El Bosque
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional Universidad El Bosque
dc.identifier.repourl.none.fl_str_mv repourl:https://repositorio.unbosque.edu.co
url https://hdl.handle.net/20.500.12495/15562
identifier_str_mv instname:Universidad El Bosque
reponame:Repositorio Institucional Universidad El Bosque
repourl:https://repositorio.unbosque.edu.co
dc.language.iso.fl_str_mv spa
language spa
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2. Instituto Nacional de Cancerología. Anuario estadístico 2022. Bogotá, D. C. 2023; Available from: www.cancer.gov.co
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4. Esteva FJ, Katz E. Tailoring Neoadjuvant Therapy in Human Epidermal Growth Factor Receptor 2–Positive Early Breast Cancer: Recent Advances and Strategies. JCO Oncol Pract. 2024 Mar 12;
5. Breast Cancer Trialists E, Group C. Articles Comparisons between diff erent polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100 000 women in 123 randomised trials. The Lancet [Internet]. 2012;379:432–44. Available from: www.thelancet.com
6. Arteaga CL, Sliwkowski MX, Osborne CK, Perez EA, Puglisi F, Gianni L. Treatment of HER2-positive breast cancer: Current status and future perspectives. Vol. 9, Nature Reviews Clinical Oncology. 2012. p. 16–32.
7. Loibl S, André F, Bachelot T, Barrios CH, Bergh J, Burstein HJ, et al. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up 5 behalf of the ESMO Guidelines Committee. 2024;46. Available from: https://doi.org/10.1016/j.
8. Romond EH, Jeong JH, Rastogi P, Swain SM, Geyer CE, Ewer MS, et al. Seven-year follow-up assessment of cardiac function in NSABP B-31, a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel (ACP) with ACP plus trastuzumab as adjuvant therapy for patients with node-positive, human epidermal growth factor receptor 2-positive breast cancer. Journal of Clinical Oncology. 2012 Nov 1;30(31):3792–9.
9. Advani PP, Ballman K V., Dockter TJ, Colon-Otero G, Perez EA. Long-term cardiac safety analysis of NCCTG N9831 (Alliance) adjuvant trastuzumab trial. Journal of Clinical Oncology. 2016 Feb 20;34(6):581–7.
10. Tallman MS, Gray R, Bennett JM, Variakojis D, Robert N, Wood WC, et al. Leukemogenic Potential of Adjuvant Chemotherapy for Early-Stage Breast Cancer: The Eastern Cooperative Oncology Group Experience. 1995.
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12. Slamon DJ, Eiermann W, Robert NJ. Ten-year follow-up of BCIRG-006 comparing doxorubicin plus cyclophosphamide followed by docetaxel with doxorubicin plus cyclophosphamide followed by docetaxel and trastuzumab with docetaxel, carboplatin and trastuzumab in HER2-positive early breast cancer patients. San Antonio Breast Cancer Symposium [Internet]. 2015 Dec 11 [cited 2024 Jul 21];Abstract S5-04. Available from: https://ascopost.com/issues/march-10-2016/final-analysis-of-bcirg-006-supports-use-of-nonanthracycline-containing-regimen-in-treatment-of-women-with-early-breast-cancer/
13. Hurvitz SA, McAndrew NP, Bardia A, Press MF, Pegram M, Crown JP, et al. A careful reassessment of anthracycline use in curable breast cancer. Vol. 7, npj Breast Cancer. Nature Research; 2021.
14. van Ramshorst MS, van der Voort A, van Werkhoven ED, Mandjes IA, Kemper I, Dezentjé VO, et al. Neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2 blockade for HER2-positive breast cancer (TRAIN-2): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol. 2018 Dec 1;19(12):1630–40.
15. Quintero Ortiz MA, Ballén DF, Briceño Morales X, Bruges Maya R, Contreras Mejía F, Sánchez Castillo JO, et al. Indicaciones para el uso de pertuzumab en cáncer de mama HER2 positivo no metastásico en los escenarios neoadyuvante y adyuvante. Revisión de la evidencia y abordaje terapéutico en el Instituto Nacional de Cancerología - Colombia. Revista Colombiana de Cancerología. 2023 Feb 1;27(Supl. 1):16–25.
16. Rashmi Kumar N, Schonfeld R, Gradishar WJ, Lurie RH, Moran MS, Abraham J, et al. NCCN Guidelines Version 4.2024 Breast Cancer [Internet]. 2024. Available from: https://www.nccn.org/
17. Swain SM, Ewer MS, Viale G, Delaloge S, Ferrero JM, Verrill M, et al. Pertuzumab, trastuzumab, and standard anthracycline- and taxane-based chemotherapy for the neoadjuvant treatment of patients with HER2-positive localized breast cancer (BERENICE): A phase II, open-label, multicenter, multinational cardiac safety study. Annals of Oncology. 2018 Mar 1;29(3):646–53.
18. Reina Sofi H, Gianni L, Pienkowski T, Im YH, Roman L, Tseng LM, et al. Effi cacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, infl ammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Articles Lancet Oncol [Internet]. 2012;13:25–32. Available from: www.thelancet.com/oncology
19. Schneeweiss A, Chia S, Hickish T, Harvey V, Eniu A, Hegg R, et al. Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: A randomized phase II cardiac safety study (TRYPHAENA). Annals of Oncology. 2013 Sep;24(9):2278–84.
20. Schneeweiss A, Chia S, Hickish T, Harvey V, Eniu A, Waldron-Lynch M, et al. Long-term efficacy analysis of the randomised, phase II TRYPHAENA cardiac safety study: Evaluating pertuzumab and trastuzumab plus standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer. Eur J Cancer. 2018 Jan 1;89:27–35.
21. Pathological Complete Response in Neoadjuvant Treatment of High-Risk Early-Stage Breast Cancer: Use as an Endpoint to Support Accelerated Approval Guidance for Industry [Internet]. 2020. Available from: https://www.fda.gov/drugs/guidance-compliance-regulatory-information/guidances-drugsand/or
22. Dang C, Ewer MS, Delaloge S, Ferrero JM, Colomer R, de la Cruz-Merino L, et al. BERENICE Final Analysis: Cardiac Safety Study of Neoadjuvant Pertuzumab, Trastuzumab, and Chemotherapy Followed by Adjuvant Pertuzumab and Trastuzumab in HER2-Positive Early Breast Cancer. Cancers (Basel). 2022 Jun 1;14(11).
23. Van Der Voort A, Van Ramshorst MS, Van Werkhoven ED, Mandjes IA, Kemper I, Vulink AJ, et al. Three-Year Follow-up of Neoadjuvant Chemotherapy with or without Anthracyclines in the Presence of Dual ERBB2 Blockade in Patients with ERBB2 -Positive Breast Cancer: A Secondary Analysis of the TRAIN-2 Randomized, Phase 3 Trial. JAMA Oncol. 2021 Jul 1;7(7):978–84.
24. Villacampa G, Matikas A, Oliveira M, Prat A, Pascual T, Papakonstantinou A. Landscape of neoadjuvant therapy in HER2-positive breast cancer: a systematic review and network meta-analysis. Eur J Cancer. 2023 Sep 1;190.
25. Cuello J, Fidalgo A, Lopez L, Llinas N. Quimioterapia neoadyuvante libre de antraciclinas en cáncer de mama Her2 positivo : estudio cuasiexperimental de eficacia y seguridad cardiovascular por puntajes de propensión. RevColHematolOncol. 2023;9.
26. de Pinho IS, Luz P, Alves L, Lopes-Brás R, Patel V, Esperança-Martins M, et al. Anthracyclines versus No Anthracyclines in the Neoadjuvant Strategy for HER2+ Breast Cancer: Real-World Evidence. Clin Drug Investig. 2023 Sep 1;
27. Lu H, Yan H, Liao S, Deng J, Zhang J, Yao F, et al. Efficacy, cardiotoxicity and factors affecting pathologic complete response of neoadjuvant chemotherapy with anthracycline-containing verses anthracycline-free regimens plus dual HER2 blockade for HER2-positive early-stage breast cancer: a retrospective study. Transl Cancer Res. 2023;12(6):1490–502.
28. Cortazar, P., Zhang, L., Untch, M., Mehta, K., Costantino, J. P., Wolmark, N., Bonnefoi, H., Cameron, D., Gianni, L., Valagussa, P., Swain, S. M., Prowell, T., Loibl, S., Wickerham, D. L., Bogaerts, J., Baselga, J., Perou, C., Blumenthal, G., Blohmer, J., Mamounas, E. P., … von Minckwitz, G. (2014). Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet (London, England), 384(9938), 164–172. https://doi.org/10.1016/S0140-6736(13)62422-8
29. Reinert, T., de Souza, A. B. A., Sartori, G. P., Obst, F. M., & Barrios, C. H. (2021). Highlights of the 17th St Gallen International Breast Cancer Conference 2021: customising local and systemic therapies. Ecancermedicalscience, 15, 1236. https://doi.org/10.3332/ecancer.2021.1236
30. Ditsch N, Gnant M, Thomssen C, Harbeck N; St. Gallen/Vienna 2025 Summary of Key Messages on Therapy in Early Breast Cancer from the 2025 St. Gallen International Breast Cancer Conference. Breast Care 2025; https://doi.org/10.1159/000546080
31. Kolberg-Liedtke C, Lüftner D, Brucker SY, Budach W, Denkert C, Fasching PA, et al. Practice-Changing Perspectives regarding Systemic Therapy in Early Breast Cancer: Opinions of German Experts regarding the 17th St. Gallen International Consensus Conference. In: Breast Care. S. Karger AG; 2022. p. 336–45
32. Elghazaly H, Azim HA, Rugo HS, Cameron D, Swain SM, Curigliano G, et al. Tailoring neoadjuvant systemic therapy in breast cancer: “The advent of a personalized approach”—The Breast-Gynecological and Immuno-Oncology International Cancer Conference (BGICC) consensus and recommendations. Cancer. 2024 Oct 1;130(19):3251–71.
33. Gao HF, Li W, Wu Z, Dong J, Cao Y, Zhao Y, et al. De-escalated neoadjuvant taxane plus trastuzumab and pertuzumab with or without carboplatin in HER2-positive early breast cancer (neoCARHP): A multicentre, open-label, randomised, phase 3 trial. 2025.
34. Nadine M. Tung et al. Predicting pathologic complete response (pCR) from clinicopathologic variables and HER2DX genomic test in stage II/III HER2+ breast cancer treated with taxane, trastuzumab, and pertuzumab (THP): Secondary results from the EA1181/CompassHER2 pCR trial.. JCO 43, 501-501(2025).DOI:10.1200/JCO.2025.43.16_suppl.501
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spelling Prieto Garzón, Lina MaríaAcevedo Ramos, Alfredo JoséZuluaga Liberato, Andrea MarcelaAcevedo Ramos, Alfredo José [0009-0009-8660-9848]Zuluaga Liberato, Andrea Marcela [0000-0002-0410-9527]2025-07-29T17:54:04Z2025-07-29T17:54:04Z2025-06https://hdl.handle.net/20.500.12495/15562instname:Universidad El Bosquereponame:Repositorio Institucional Universidad El Bosquerepourl:https://repositorio.unbosque.edu.coIntroducción: Ensayos clínicos recientes han mostrado efectividad similar entre los esquemas con y sin antraciclinas en neoadyuvancia de cáncer de mama temprano y localmente avanzado respecto a tasas de respuesta patológica completa (RPC) y supervivencia libre de evento, lo cual ha motivado una tendencia al retiro progresivo del uso de las antraciclinas en este escenario clínico, buscando disminuir efectos adversos como cardiotoxicidad y mielotoxicidad. Sin embargo, no hay estudios comparativos entre los dos esquemas más usados actualmente, derivados de los estudios BERENICE y TRAIN-2. Métodos: Se realizó un estudio observacional retrospectivo analítico con pacientes con diagnóstico de cáncer de mama HER-2 positivo temprano y localmente avanzado que iniciaron quimioterapia neoadyuvante con antraciclina (Doxorrubicina, Ciclofosfamida x 4, Taxano, Trastuzumab y Pertuzumab x 4 = AC-THP) y sin antraciclinas (Carboplatino, Paclitaxel semanal, Trastuzumab y Pertuzumab por 6-9 ciclos = TCbHP) tratados en el Instituto Nacional de Cancerología entre abril 2020 y diciembre 2024. Se evaluó en el análisis inicial respuesta patológica completa, así como toxicidad cardiaca y neurotoxicidad en ambos brazos de tratamiento. Resultados: Se incluyeron 111 pacientes en los que se definió tratamiento neoadyuvante con quimioterapia más Pertuzumab y Trastuzumab. 51 pacientes recibieron AC-THP y 60 TCbHP (89.6% recibieron 6 ciclos). No hubo diferencia estadísticamente significativa en la RPC entre los pacientes operados de cada brazo. 58.3% ACHTP y 60.4% en TCbHP (OR 1.08 IC 95% 0.49-2.36 p = 0.84). Como análisis descriptivo hubo una tendencia a mayor RPC en pacientes Tamaño tumoral T3-T4, (Compromiso ganglionar) N+ y Receptores hormonales (RH) positivos en pacientes que recibieron el brazo de antraciclinas. Los eventos de descenso de FEVI >10% con valor absolutos <50% durante la fase de neoadyuvancia fue de 9.8 y 3.3% en ACTHP vs TCbHP. Los eventos de neuropatía grado 2 se registraron en 9.8% vs 23.3% de los pacientes que recibieron TCbHP, respectivamente. Conclusiones: A pesar de usar menos ciclos que los administrados en el estudio TRAIN-2 (6 vs 9 ciclos) en la mayoría de los pacientes, encontramos tasas de RPC similares entre el esquema sin antraciclinas vs con antraciclinas. Quizás, aun es pertinente discutir el riesgo beneficio de usar esquema con antraciclinas en pacientes con RH+, T3-4 y N+ además de las consideraciones habituales de los antecedentes de factores de riesgo cardiovascular. Los eventos de cardiotoxicidad del brazo de antraciclinas fueron similares al estudio BERENICE. Por su parte registramos menos casos de neuropatía grado 2 o más que en el estudio TRAIN-2 posiblemente por el número reducido de ciclos recibidos.Instituto Nacional de CancerologíaEspecialista en Oncología ClínicaEspecializaciónIntroduction: Recent clinical trials have shown similar effectiveness between anthracycline-containing and non-anthracycline regimens in neoadjuvant treatment of early and locally advanced breast cancer with respect to pathological complete response (pCR) rates and event-free survival. This has motivated a trend toward progressive withdrawal of anthracyclines in this clinical setting, seeking to reduce adverse effects such as cardiotoxicity and myelotoxicity. However, there are no comparative studies between the two most currently used regimens, derived from the BERENICE and TRAIN-2 studies. Methods: An analytical retrospective observational study was conducted with patients diagnosed with early, locally advanced HER-2 positive breast cancer who started neoadjuvant chemotherapy with anthracyclines (Doxorubicin, Cyclophosphamide x 4, Taxane, Trastuzumab and Pertuzumab x 4 = AC-THP) and without anthracyclines (Carboplatin, Paclitaxel weekly, Trastuzumab and Pertuzumab for 6-9 cycles = TCbHP) treated at the National Cancer Institute between April 2020 and December 2024. Complete pathological response, as well as cardiac toxicity and neurotoxicity in both treatment arms, were evaluated in the initial analysis. Results: A total of 111 patients were included in whom neoadjuvant treatment with chemotherapy plus pertuzumab and trastuzumab were defined. 51 patients received AC-THP and 60 received TCbHP (89.6% received 6 cycles). There was no statistically significant difference in pCR between patients operated on in each arm. 58.3% received ACHTP and 60.4% in TCbHP (OR 1.08 95% CI 0.49-2.36 p = 0.84). A descriptive analysis showed a trend toward higher pCR in T3-T4, N+, and ER-positive patients compared to patients who received the anthracycline arm. The incidence of LVEF decline >10% with an absolute value <50% during the neoadjuvant phase was 9.8% and 3.3% in ACTHP vs TCbHP. Grade 2 neuropathy events were reported in 9.8% vs. 23.3% of patients receiving TCbHP, respectively. Conclusions: Despite using fewer cycles than those administered in the TRAIN-2 study (6 vs 9 cycles) in most patients, we found similar pCR rates between the anthracycline-free regimen and the anthracycline-containing regimen. It is perhaps still pertinent to discuss the risk-benefit of using an anthracycline-containing regimen in patients with HR+, T3-4, and N+, in addition to the usual considerations of cardiovascular risk factors. Cardiotoxicity events in the anthracycline arm were similar to those in the BERENICE study. We recorded fewer cases of grade 2 or higher neuropathy than in the TRAIN-2 study, possibly due to the reduced number of cycles received.application/pdfAttribution-NonCommercial-ShareAlike 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-sa/4.0/Acceso abiertohttps://purl.org/coar/access_right/c_abf2http://purl.org/coar/access_right/c_abf2Cáncer de mamaHER2 positivoNeoadyuvanciaAntraciclinasRespuesta patológica completaBreast cancerHER2 positiveNeoadjuvantAnthracyclinesPathological complete responseQZ 200Desenlaces oncológicos y seguridad del tratamiento neoadyuvante con y sin antraciclinas en cáncer de mama temprano y localmente avanzado HER-2 positivo en el Instituto Nacional de CancerologíaOncologic Outcomes and Safety of Neoadjuvant Treatment with Anthracyclines Versus Anthracycline-free Regimens in HER2-Positive Early Breast Cancer in a National Cancer InstituteEspecialización en Oncología ClínicaUniversidad El BosqueFacultad de MedicinaTesis/Trabajo de grado - Monografía - Especializaciónhttps://purl.org/coar/resource_type/c_7a1fhttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesishttps://purl.org/coar/version/c_ab4af688f83e57aa1. 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