1/10/2024 0 Comments Pcr her2 breast cancer![]() Patients’ and providers’ acceptance of a pCR-based de-escalated treatment approach has not been formally investigated. The CompassHER2-pCR trial (NCT04266249) is ongoing and will determine recurrence-free survival among patients with HER2+ breast cancer who receive an abbreviated neoadjuvant regimen and experience pCR, then omit additional standard cytotoxic chemotherapy. Preliminary data indicate that pCR correlates with excellent long-term outcomes in HER2+ breast cancer even when the neoadjuvant regimen is chemotherapy-sparing or otherwise non-standard 7, 8. pCR is associated with an excellent long-term outcome and may identify patients who are prime candidates for de-escalated adjuvant treatment. Pathologic complete response (pCR) at surgery following neoadjuvant therapy is a strong favorable prognostic biomarker in all subtypes of breast cancer, including HER2+ breast cancer treated with standard modern regimens incorporating HER2-targeted therapy 4, 5, 6. It is of great interest to determine if a subset of patients with anatomic stage II-III HER2+ breast cancer can be adequately treated with curative intent using less toxic therapy. However, current standard-of-care neo/adjuvant regimens for stage II-III HER2+ breast cancer involve 2–3 chemotherapy agents plus HER2-directed therapy 2, and these regimens are associated with both serious and burdensome short- and long-term toxicities 3. The APHINITY trial demonstrated 3-year invasive disease-free survival (DFS) of 92% among node-positive early-stage HER2+ breast cancer patients treated with trastuzumab (H) and pertuzumab (P) plus adjuvant chemotherapy 1. Modern treatment regimens for human epidermal growth factor receptor 2-positive (HER2+) breast cancer produce favorable long-term outcomes in the vast majority of patients with non-metastatic disease. Planned and ongoing prospective trials will determine the long-term efficacy of this approach. De-escalation of adjuvant chemotherapy among patients who experience pCR in early-stage HER2+ breast cancer is a practicable approach for both patients and physicians. With brief follow-up (median 19.1 months), there were no breast cancer recurrences. The majority of patients felt positive or neutral about their adjuvant treatment plans. Among patients with pCR, the adherence rate to de-escalated antibody-only therapy (HP) was 98.2% (95% CI 90.3–100.0%), and the primary feasibility endpoint was reached. Five patients had incomplete clinical response following THP and received doxorubicin and cyclophosphamide before surgery they were classified as non-pCR and censored from further analyses. Patients had median age of 50 years, 86% had stage II tumors, and 34% were hormone receptor-negative. Ninety-eight patients received ≥1 dose of THP on study. The primary endpoint was receipt of adjuvant non-HER2-directed cytotoxic chemotherapy. In this single-arm prospective trial, patients with treatment-naïve stage II-III HER2+ breast cancer received neoadjuvant weekly paclitaxel ×12 and HP every 3 weeks ×4. We aimed to assess adherence to de-escalated adjuvant antibody doublet therapy (trastuzumab and pertuzumab, without chemotherapy) among patients with pCR following neoadjuvant paclitaxel/HP (THP). However, the feasibility of this approach and its appeal to patients and providers had not been formally investigated. Npj Breast Cancer volume 8, Article number: 63 ( 2022)ĭe-escalating adjuvant therapy following pathologic complete response (pCR) to an abbreviated neoadjuvant regimen in human epidermal growth factor receptor 2-positive (HER2+) breast cancer is the focus of international research efforts. A prospective trial of treatment de-escalation following neoadjuvant paclitaxel/trastuzumab/pertuzumab in HER2-positive breast cancer ![]()
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