Preoperative Drug Therapy in Her2-Positive Breast Cancer
Keywords:
Neoadjuvant Therapy,, Dual anti-Her2 Therapy,, Pathological Complete Response (pCR)Abstract
Background: Her2-positive breast cancer is one of the most aggressive and recurrent breast cancers. Conventional treatment involves chemotherapy and anti-Her2 drugs after surgery. However, preoperative neoadjuvant therapy has become increasingly popular because it can reduce the size of the tumor, allowing breast preservation and reducing the chance of cancer cells spreading. This study aimed to review the results of dual anti-Her2 therapy (Trastuzumab and Pertuzumab) in combination with preoperative chemotherapy to assess the clinical outcomes and the chance of achieving pathological complete response (pCR), which is related to long-term patient survival.
Objectives: (1) To study the efficacy of dual anti-Her2 therapy in reducing tumor size and pCR response rate; (2) To compare the survival rate of patients receiving neoadjuvant therapy with conventional therapy; (3) To analyze the impact of neoadjuvant therapy on reducing the need for extensive lymph node dissection.
Methodology: This study is a literature review and metastasis analysis of several clinical trials, including the NeoSphere Trial, Tryphaena Trial and Katherine Trial, which evaluated the results of preoperative chemotherapy in patients with her2-positive breast cancer. Her2-positive breast cancer using Hazard Ratio (HR) statistical analysis and comparison of overall survival (OS) and disease-free survival (DFS) rates.
Results (1) Dual anti-Her2 therapy combined with chemotherapy prior to surgery resulted in pCR of 45.8%-67%, depending on the regimen and duration of therapy. (2) The group receiving Neoadjuvant Therapy had better disease-free survival, especially in the group that achieved pCR. (3) Long-term studies showed that patients with pCR had significantly higher overall survival than those who did not achieve pCR. (4) The use of T-DM1 in patients who did not achieve pCR after Neoadjuvant Therapy reduced the rate of disease recurrence.
Conclusion: Preoperative dual anti-Her2 therapy combined with chemotherapy can increase the chance of achieving pCR and improve long-term survival. It also reduces tumor size, allows for more breast-conserving surgery, and reduces the need for lymph node dissection, which is an effective approach for treating Her2-positive breast cancer.
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