With the rapid development of targeted therapeutics, targeted drugs continue to be introduced to bring new tools to the neoadjuvant treatment of breast cancer. This article takes a look at them.
What is the role of neoadjuvant therapy?
What does neoadjuvant therapy do?
Pathologic complete remission (pCR) is a very important indicator of neoadjuvant therapy, which is the state of being microscopically free of cancer cells after treatment. When patients achieve pCR with neoadjuvant chemotherapy, they can have a longer survival.
In the United States, neoadjuvant therapy is often recommended for HER-2-positive breast cancer with tumors ≥2 cm, regardless of lymph node status. The reasons for this are threefold: there is clear information that survival is significantly improved when patients have achieved pCR; the hope is that tumor downstaging will reduce the extent of surgical clearance of lymph nodes or allow for exemption from radiation therapy; and neoadjuvant therapy gives physicians the opportunity to identify tumor responsiveness to anti-HER-2 therapy and to guide the intensity of local therapy.
The status of neoadjuvant therapy remains somewhat controversial; it does not significantly improve survival outcomes compared with adjuvant therapy, but those who achieve pCR have better survival outcomes, as demonstrated by longer survival, compared with those who do not achieve pCR.
So for HER-2-positive breast cancer, if neoadjuvant therapy is chosen, physicians will try to achieve pCR status, and if pCR is not achieved, great attention is usually paid to late follow-up and monitoring.
What drugs are available for neoadjuvant therapy?
For HER-2 positive patients, there is no need to use any of these drugs.
For HER-2-positive breast cancer, doctors consider trastuzumab (Trastuzumab ) in neoadjuvant therapy, and trastuzumab in combination with chemotherapy can significantly improve the chances of pCR compared to chemotherapy alone. In the postoperative adjuvant phase, trastuzumab is usually continued for a total of 1 year of treatment.
In preoperative neoadjuvant therapy, the regimen may be the recommended regimen for adjuvant therapy, such as the TCH regimen [docetaxel + carboplatin + trastuzumab], or the physician may choose an anthracycline-containing combination, but trastuzumab is usually used in conjunction with an anthracycline for no more than 4 cycles.
Sometimes, physicians may also consider a “dual-target” regimen of two anti-HER-2 drugs in neoadjuvant therapy. Some studies have shown that the combination of lapatinib or pertuzumab with trastuzumab in a dual-targeted chemotherapy regimen can further improve outcomes. “Dual-targeted” therapy has a high rate of achieving pCR and can be safely combined with chemotherapy. Some HER-2-positive breast cancers can also achieve pCR with dual-targeted therapy without chemotherapy, which means that some patients may be spared the side effects of chemotherapy.
Targeted agents have opened up more options for neoadjuvant therapy for HER-2-positive breast cancer. Consult your doctor for advice on which neoadjuvant treatment strategy is best for you. (Contributed by Yuqing Yang, Department of Nail and Breast Vascular Surgery, Xijing Hospital, Air Force Military Medical University)