Advances and optimization in the treatment schedule of HER2-positive breast cancer
10.3872/j.issn.1007-385x.2020.05.001
- VernacularTitle:HER2阳性乳腺癌治疗模式的进展和优化
- Author:
YANG Yanfang
1
;
JIANG Zhansheng
2
,
3
;
GU Lin
1
Author Information
1. a. Second Department of Breast Cancer
2. b. Department of Integrated Chinese and Western Medicine, Key Laboratory of Breast Cancer Prevention and Therapy of the Ministry of Education, Tianjin&rsquo
3. s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy of Tianjin City, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
- Publication Type:Journal Article
- Keywords:
human epidermal growth factor receptor 2 (HER2);
breast cancer;
therapeutic schedule;
progression;
optimization
- From:
Chinese Journal of Cancer Biotherapy
2020;27(5):469-476
- CountryChina
- Language:Chinese
-
Abstract:
The efficacy and prognosis of human epidermal growth factor receptor 2 (HER2) positive breast cancer patients have been significantly improved with the development and wide application of anti-tumor drugs against HER2. The results of PEONY research once again established the status of the double-target treatment mode of pertuzumab+trastuzumab in the field of neoadjuvant therapy. Based on the two studies of TRYPHAENA and TRAIN-2, paclitaxel plus platinum should be the first choice chemotherapy scheme for anti HER2 double-target therapy, and the treatment course of 6 cycles is preferred. According to the consensus of neoadjuvant therapy experts in China and the latest follow-up results of adjuvant APT study, the neoadjuvant therapy is more suitable for patients with a tumor diameter of more than 3 cm and/or positive lymph nodes metastasis; T-DM1 should be the first choice of adjuvant therapy in patients, who didn’t obtain pCR after neoadjuvant treatment, and whether the double-target adjuvant mode of pertuzumab plus trastuzumab is suitable depends on follow-up of the PEONY study. Low-risk patients with small tumors (<3 cm) and without lymph node metastasis may consider omitting neoadjuvant therapy but adopt direct surgery followed by postoperative adjuvant therapy with trastuzumab plus paclitaxel. The regimen of trastuzumab+pertuzumab combined with taxanes is still the standard first line treatment of late stage HER2+ patients; for Chinese patients, pyrotinib combined with capecitabine can be used as the second line optimization, and T-DM1 can be used as the third line and posterior line selection; when trastuzumab, pertuzumab and T-DM1 fail the treatment, DS-8201 becomes a new selection mode. Combined treatment mode of tucatinib plus trastuzumab and capecitabine can be considered in late stage HER2+ patients with brain metastases.
- Full text:20200501.pdf
