No outside funding supported this study. The authors declare that they have no affiliations with or financial interests in any company, product, or service described in the manuscript. Study concept and design were contributed by Sierra-Sánchez, Martínez-Bautista, Baena-Cañada, and González-Carrascosa Vega. Martínez-Bautista, García-Martín, Suárez-Carrascosa, and González-Carrascosa Vega collected the data, which was interpreted by Sierra-Sánchez, Martínez-Bautista, Baena-Cañada, and González-Carrascosa Vega. The manuscript was written by Sierra-Sánchez and González-Carrascosa Vega and revised by Sierra-Sánchez, Martínez-Bautista, Baena-Cañada, and González-Carrascosa Vega.

The proposed antiemetic protocol is effective for controlling vomiting in chemotherapy regimens with an HL of 1-3. For highly emetogenic regimens, the antiemetic protocol is also effective, but protection is not complete. This protocol seems less effective for controlling nausea, although this is a subjective symptom which is difficult to assess and not routinely measured in clinical trials.

No abstract

Adjuvant trastuzumab in HER2+ breast cancer reduces recurrence and mortality, and has been the standard treatment since 2006. The objective was to analyze health outcomes in the real world. Observational, retrospective study of patients with HER2+ breast cancer, stages I–III, treated with adjuvant trastuzumab in the past 15 years in only one center and for the first time in Spain. Survival was analyzed according to the number of cycles and cardiotoxicity. Two hundred and seventy-five HER2positive patients (18.60%) out of 1479 received adjuvant (73%) or neoadjuvant/adjuvant (26%) trastuzumab, concomitantly (90%) or sequentially (10%) with chemotherapy. The probability of overall and disease-free survival (OS and DFS) at 5 years was 0.93 (95% CI 0.89–0.96), and 0.88 (95% CI 0.83–0.92). The number of cases with a significant and asymptomatic decrease in ventricular ejection fraction and heart failure were 54 (19.64%) and 12 (4.36%), respectively. Sixty-eight patients (24.70%) received 16 or fewer cycles, especially those older than 65 (OR 0.371, 95% CI 0.152–0.903; p = 0.029) and with cardiotoxicity (OR 15.02, 95% CI 7.437–30.335; p < 0.001). The risk of cardiotoxicity was associated with having received radiotherapy (OR 0.0362, 95% CI 0.139–0.938; p = 0.037). Arterial hypertension (HR 0.361, 95% CI 0.151–0.863, p = 0.022), neoadjuvant treatment (HR 0.314, 95% CI 0.132–0.750, p = 0.009) and cardiotoxicity (HR 2.755, 95% CI 1.235–6.143, p = 0.013) maintained significant association with OS. Only neoadjuvant treatment maintained a significant association with DFS (HR 0.437, 95% CI 0.213–0.899, p = 0.024). The effectiveness of neoadjuvant and adjuvant trastuzumab can be considered comparable to those of clinical trials. In the real world, factors such as age, hypertension, radiotherapy, neoadjuvant treatment, and cardiotoxicity should be taken into consideration to optimize outcomes.