Invited commentary on “Neoadjuvant pertuzumab plus trastuzumab in combination with anthracycline-free chemotherapy regimen in patients with HER2 positive breast cancer: Real-world data from a single center in India”.

Abstract

The article “Neoadjuvant pertuzumab plus trastuzumab in combination with anthracycline-free chemotherapy regimen in patients with HER2 positive breast cancer: Real-world data from a single center in India” have presented the experience of neoadjuvant DCPH in Indian population. Though being a small retrospective study, results from this study have provided the medical community a real-world data on Asian (in particular Indian) population.In Hong Kong, we have reviewed our prospective database. 264 primary breast cancer patients underwent neoadjuvant chemotherapy followed by definitive breast surgery in my institution from 2005 to 2015. Mean age was 48.9 years old. Mean tumor size was 44.9 mm. 58 (22%) patients had HER2 positive invasive cancer. 16 (6.1%) were stage 1, 213 (80.7%%) were stage 2, the rest were stage 3 cancers.PCR rate was observed in 29 (11%) patients after neoadjuvant chemotherapy. Amongst which, PCR rate is higher in HER2 positive breast cancers (25.9%) followed by triple negative cancers (13.3%) and then luminal cancers (5.7%). Patients with HER2 positive cancers had 70.7% reduction of breast tumor volume on sonographic measurement after anti-HER2 neoadjuvant treatment. Breast cancers with HER2 positive cancers were associated with higher PCR rate (p= 0.029). Overall rate of breast conserving surgery (BCS) increased to from 14.7% to 30.5% after neoadjuvant treatment.Neoadjuvant systemic treatment results in significant tumor shrinkage in many patients. It has expanded the indication of BCS, although BCS rate in Asia remains relatively low due to personal choice and small breast volume in the population.