Efficacy of Neoadjuvant Single or Dual Anti-HER-2 Therapy Combined with Chemotherapy in Patients with HER-2-Positive Breast Cancer: A Single-Center Retrospective Study.

Qian He,Jia-Yi Li,Qing-Lan Ren

doi:10.31557/apjcp.2021.22.5.1467

Abstract

Background:Studies have shown that neoadjuvant anti-HER-2 therapy and chemotherapy can increase pathologic complete response (pCR) rate in HER-2-positive breast cancer patients and improve prognosis. However, data from Chinese patients are limited. Therefore, we conducted a single-center retrospective study to evaluate the effects of neoadjuvant single or dual anti-HER-2 therapy and chemotherapy in Chinese HER-2-positive breast cancer patients and to explore the prognostic indicators of pCR and progression-free survival (PFS). Methods:We included patients with HER-2-positive breast cancer treated with neoadjuvant anti-HER-2 therapy and chemotherapy at the First Affiliated Hospital of Chongqing Medical University in China from January 2016 to July 2020. We analyzed the relationship between patient characteristics and the pCR rate or PFS. Results:Forty-seven patients with HER-2-positive breast cancer receiving neoadjuvant anti-HER-2 therapy and chemotherapy were included. Univariate analysis suggested that compared with patients receiving neoadjuvant single anti-HER-2 therapy, patients receiving neoadjuvant dual anti-HER-2 therapy tended to have a higher pCR rate and better PFS. Patients who achieved pCR also tended to have longer PFS. Multivariate analysis indicated that patients with greater systemic inflammation response index (SIRI) reduction (>0.54) during neoadjuvant treatment (NAT) and patients with a lower T stage were more likely to achieve pCR. Patients aged ≤60 years with lower Ki-67 had longer PFS. Conclusion:Greater SIRI reduction during NAT was an independent influencing factor for pCR. Patients receiving neoadjuvant dual anti-HER-2 therapy and chemotherapy tended to have higher pCR rates and longer PFS. Patients who achieved pCR also tended to have longer PFS.

Highlights

Breast cancer is the most common cancer in women and is one of the leading causes of cancer-related death in women (Siegel et al, 2019)
Studies have found that the addition of targeted therapy to preoperative neoadjuvant therapy can improve the prognosis of HER-2-positive breast cancer patients without significantly increasing cardiac toxicity (Petrelli et al, 2011; Schneeweiss et al, 2013)
The NeoSphere study found that in patients with HER-2-positive breast cancer, preoperative neoadjuvant chemotherapy (NAC) combined with dual anti-HER-2 therapy significantly increased pathologic complete response compared with chemotherapy combined with single anti-HER-2 therapy

Summary

Introduction

Breast cancer is the most common cancer in women and is one of the leading causes of cancer-related death in women (Siegel et al, 2019). The NeoSphere study found that in patients with HER-2-positive breast cancer, preoperative neoadjuvant chemotherapy (NAC) combined with dual anti-HER-2 therapy (trastuzumab and pertuzumab) significantly increased pathologic complete response (pCR) compared with chemotherapy combined with single anti-HER-2 therapy. Data have demonstrated that low PNI status before surgery or PNI reduction during NAC is a predictor of poor prognosis in many malignancies, including breast cancer (Tokunaga et al, 2015; Mohri et al, 2016; He et al, 2017; Migita et al, 2017; Hua et al, 2019; Oba. Studies have shown that neoadjuvant anti-HER-2 therapy and chemotherapy can increase pathologic complete response (pCR) rate in HER-2-positive breast cancer patients and improve prognosis. Patients receiving neoadjuvant dual anti-HER-2 therapy and chemotherapy tended to have higher pCR rates and longer PFS. Patients who achieved pCR tended to have longer PFS

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