Neoadjuvant treatment in a patient with HER2-positive breast cancer — a case study and review of recent recommendations
Abstract
Pre-operative breast cancer therapy (neoadjuvant or induction) is reserved for patients with locally advanced tumours primarily amenable to surgery (neoadjuvant treatment) or subjects with initially unresectable disease in whom respectability may be achieved following upfront systemic treatment (induction therapy). Initial systemic treatment may be used in all phenotypes of breast cancer. Patients with "triple-negative" breast cancer (TNBC) or human epidermal growth factor receptor 2 (HER-2)-positive tumours benefit most from preoperative therapy. Patients in this group most often achieve pathological complete response (pCR), which results in an improved prognosis. In this report, we present a case of complete tumour regression following neoadjuvant chemotherapy combined with trastuzumab (currently a non-reimbursed indication in Poland) and we review the literature on this issue.
Keywords: breast cancerneoadjuvant treatmenttrastuzumabpathological complete response
References
- Fisher B, Bryant J, Wolmark N, et al. Effect of preoperative chemotherapy on the outcome of women with operable breast cancer. J Clin Oncol. 1998; 16(8): 2672–2685.
- Tokajuk P, Czartoryska-Arłukowicz B, Wojtukiewicz MZ. Leczenie interferujące z funkcją EGFR u chorych na raka piersi. Onkol Prakt Klin. 2011; 7: 159–176.
- Wojtukiewicz MZ, Sierko E. Leczenie ukierunkowane na cele molekularne w onkologii i hematoonkologii. Via Medica, Gdańsk 2013: 240–269.
- Moja L, Tagliabue L, Balduzzi S, et al. Trastuzumab containing regimens for early breast cancer. Cochrane Database Syst Rev. 2012(4): CD006243.
- Goldhirsch A, Gelber RD, Piccart-Gebhart MJ, et al. Herceptin Adjuvant (HERA) Trial Study Team. 2 years versus 1 year of adjuvant trastuzumab for HER2-positive breast cancer (HERA): an open-label, randomised controlled trial. Lancet. 2013; 382(9897): 1021–1028.
- Pivot X, Romieu G, Debled M, et al. PHARE trial investigators. 6 months versus 12 months of adjuvant trastuzumab for patients with HER2-positive early breast cancer (PHARE): a randomised phase 3 trial. Lancet Oncol. 2013; 14(8): 741–748.
- Gianni L, Eiermann W, Semiglazov V, et al. Neoadjuvant and adjuvant trastuzumab in patients with HER2-positive locally advanced breast cancer (NOAH): follow-up of a randomised controlled superiority trial with a parallel HER2-negative cohort. The Lancet Oncology. 2014; 15(6): 640–647.
- Baselga J, Bradbury I, Eidtmann H, et al. NeoALTTO Study Team. Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomised, open-label, multicentre, phase 3 trial. Lancet. 2012; 379(9816): 633–640.
- Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol. 2012; 13(1): 25–32.
- Green MC, Buzdar AU, Smith T, et al. Weekly paclitaxel improves pathologic complete remission in operable breast cancer when compared with paclitaxel once every 3 weeks. J Clin Oncol. 2005; 23(25): 5983–5992.
- von Minckwitz G, Untch M, Blohmer JU, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012; 30(15): 1796–1804.
- Mayer EL, Gropper AB, Harris L, et al. Long-term follow-up after preoperative trastuzumab and chemotherapy for HER2-overexpressing breast cancer. Clin Breast Cancer. 2015; 15(1): 24–30.
- Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet. 2014; 384(9938): 164–172.
- Tanioka M, Sasaki M, Shimomura A, et al. Pathologic complete response after neoadjuvant chemotherapy in HER2-overexpressing breast cancer according to hormonal receptor status. Breast. 2014; 23(4): 466–472.
- NCCN Clinical Practice Guidelines in Oncology: Breast Cancer. Version 2.2015.
- Salim DK, Mutlu H, Eryilmaz MK, et al. Molecular types and neoadjuvant chemotherapy in patients with breast cancer- while molecular shifting is more common in luminal a tumors, the pathologic complete response is most frequently observed in her-2 like tumors. Asian Pac J Cancer Prev. 2014; 15(21): 9379–9383.
- on Minckwitz G, Loib S, Untch M. What is the current standard of care for anti-HER2 neoadjuvant therapy in breast cancer? Oncol J 2012; published on Cancer Network. www.cancernetwork.com.
- ClinicalTrials.gov. A service of the U.S. National Institutes of Health.