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Review paper
Published online: 2022-07-01
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The role of anthracycline and pertuzumab in preoperative treatment of HER2-positive breast cancer

Sylwia Dębska-Szmich12, Piotr Potemski12
DOI: 10.5603/OCP.2022.0012
Affiliations
  1. Chemotherapy Clinic, Oncology Department, Medical University of Lodz
  2. Nicolaus Copernicus Multidisciplinary Center for Oncology and Traumatology, Lodz, Poland

open access

Ahead of print
REVIEW ARTICLES
Published online: 2022-07-01

Abstract

Polychemotherapy combined with trastuzumab (T) or trastuzumab with pertuzumab (TP) is a standard preoperative systemic treatment in patients with HER2-positive breast cancer. In Poland T is reimbursed according to the Drug Prescription Program of Ministry of Health (MoH) for patients with primary breast tumors bigger than 1cm independently from nodal status, whereas TP is reimbursed for patients with tumors bigger than 2 cm with positive lymph node(s) or lack of hormonal receptors expression. The Drug Prescription Program does not indicate which polychemotherapy should be combined with anti-HER2 therapy. Therefore, one can choose between classical sequential treatment based on anthracycline and taxane combined with T or dual HER2 blockade (usually 4 × AC → 12 × paclitaxel/4 × docetaxel + T/TP), or docetaxel with carboplatin combined with trastuzumab (TCH) or with dual HER2 blockade (TCHP). According to the present guidelines of the National Comprehensive Cancer Network (NCCN), polychemotherapy without anthracycline is preferred, which is justified because of its lower toxicity, especially cardiotoxicity. Currently, a pathologically confirmed complete response (pCR) is usually the primary objective in clinical trials dedicated to preoperative systemic treatment in breast cancer. pCR became a surrogate of treatment effectiveness. That is why oncologists eagerly use polychemotherapy combined with dual HER2 blockade as preoperative treatment to increase the patient’s chance to achieve pCR, sometimes even when the patient’s risk of relapse is relatively small. The goal of this article is to review current evidence-based knowledge about the effectiveness and toxicity of polychemotherapy with or without anthracycline combined with trastuzumab or dual HER2 blockade used as preoperative treatment in HER2-positive breast cancer patients.

Abstract

Polychemotherapy combined with trastuzumab (T) or trastuzumab with pertuzumab (TP) is a standard preoperative systemic treatment in patients with HER2-positive breast cancer. In Poland T is reimbursed according to the Drug Prescription Program of Ministry of Health (MoH) for patients with primary breast tumors bigger than 1cm independently from nodal status, whereas TP is reimbursed for patients with tumors bigger than 2 cm with positive lymph node(s) or lack of hormonal receptors expression. The Drug Prescription Program does not indicate which polychemotherapy should be combined with anti-HER2 therapy. Therefore, one can choose between classical sequential treatment based on anthracycline and taxane combined with T or dual HER2 blockade (usually 4 × AC → 12 × paclitaxel/4 × docetaxel + T/TP), or docetaxel with carboplatin combined with trastuzumab (TCH) or with dual HER2 blockade (TCHP). According to the present guidelines of the National Comprehensive Cancer Network (NCCN), polychemotherapy without anthracycline is preferred, which is justified because of its lower toxicity, especially cardiotoxicity. Currently, a pathologically confirmed complete response (pCR) is usually the primary objective in clinical trials dedicated to preoperative systemic treatment in breast cancer. pCR became a surrogate of treatment effectiveness. That is why oncologists eagerly use polychemotherapy combined with dual HER2 blockade as preoperative treatment to increase the patient’s chance to achieve pCR, sometimes even when the patient’s risk of relapse is relatively small. The goal of this article is to review current evidence-based knowledge about the effectiveness and toxicity of polychemotherapy with or without anthracycline combined with trastuzumab or dual HER2 blockade used as preoperative treatment in HER2-positive breast cancer patients.

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Keywords

pertuzumab; anthracycline; preoperative chemotherapy; pathologically confirmed complete response (pCR); breast cancer; overall survival

About this article
Title

The role of anthracycline and pertuzumab in preoperative treatment of HER2-positive breast cancer

Journal

Oncology in Clinical Practice

Issue

Ahead of print

Article type

Review paper

Published online

2022-07-01

Page views

79

Article views/downloads

54

DOI

10.5603/OCP.2022.0012

Keywords

pertuzumab
anthracycline
preoperative chemotherapy
pathologically confirmed complete response (pCR)
breast cancer
overall survival

Authors

Sylwia Dębska-Szmich
Piotr Potemski

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