- Adding zoledronic acid to neoadjuvant chemotherapy and trastuzumab yielded a 42% pathologic complete response (pCR) rate in a phase 2 trial of human epidermal growth factor receptor 2 (HER2)-positive breast cancer.
Why this matters
- In preclinical studies, zoledronic acid demonstrated a synergistic effect with chemotherapy, partly by interacting with the HER2 pathway.
- Zoledronic acid is a feasible, effective, affordable, and well-tolerated therapeutic option that warrants a larger, randomized controlled trial.
- Zo-NAnTax trial of 71 patients with stage IIa-IIIb breast cancer in a single Brazilian center.
- Patients received 8 cycles of zoledronic acid (4 mg/dose) accompanying 4 cycles of doxorubicin/cyclophosphamide, followed by 4 cycles of docetaxel and trastuzumab before surgery.
- Funding: None.
- The overall pCR rate was 42% (partial response, 58%).
- The pCR rate was higher in patients with nuclei/cytoplasmic β-catenin expression (P=.030).
- The pCR rate was not significantly higher in hormone receptor (HR)-negative (44%; 95% CI, 31%-56%) vs HR-positive (40%; 95% CI, 27%-52%) patients.
- The most frequent grade 3 and 4 adverse events with the entire treatment regimen were febrile neutropenia (20% and 3%, respectively) and diarrhea (12% and 0%, respectively).
- No cases of cardiotoxicity or jaw osteonecrosis were observed.
- Nonrandomized design.
- No control group.
- Single-center study.