Pcr her2 breast cancer8/31/2023 6 Furthermore, the addition of trastuzumab significantly increased the proportion of patients with a pCR in the breast (43% vs 22%, respectively). The primary endpoint of event-free survival (EFS) was met, demonstrating an absolute improvement of 15% in events when patients who received trastuzumab were compared with patients who received chemotherapy alone (hazard ratio, 0.59 95% CI, 0.38-0.90 P=.013). 6,36,37 The NOAH (Neoadjuvant Herceptin) 6 trial was the first randomized phase 3 trial to evaluate the addition of 1 year of trastuzumab (started as neoadjuvant and continued as adjuvant therapy) to neoadjuvant chemotherapy in HER2-positive LABC. In the neoadjuvant setting, the addition of trastuzumab to standard chemotherapy was a landmark in the treatment of HER2-positive breast cancer, doubling the probability of achieving a pCR. The addition of trastuzumab to standard therapy dramatically improves disease-free survival (DFS) and overall survival (OS) in both the early and advanced settings. In this article, we review the best approaches to the treatment of locally advanced HER2-positive breast cancer (see Figure for an initial approach), considering the clinical trial data that are currently available (see Table). Gallen International Expert Consensus support neoadjuvant systemic therapy for locally advanced HER2-positive breast cancer, along with surgery, radiation therapy, and (when appropriate) endocrine therapy. Therefore, current National Comprehensive Cancer Network (NCCN) guidelines and the St. Historically, the introduction of trastuzumab to neoadjuvant chemotherapy remarkably improved the probability of achieving a pathologic complete response (pCR) 9,10 with a favorable toxicity profile, which has been even further improved with the addition of pertuzumab to trastuzumab as dual HER2 blockade. 2 However, the introduction of anti-HER2 agents has changed the paradigm of HER2-positive breast cancer in the last 2 decades, leading to unprecedented survival outcomes 7-10 and modifying the natural history of the disease. Additionally, this approach provides information regarding the responsiveness of the tumor to systemic therapy.Īmplification or overexpression of human epidermal growth factor receptor 2 (HER2) is present in approximately 20% of early breast cancers and 35% of LABCs, 6 and historically it has been associated with a poor prognosis. The goals of preoperative systemic therapy are to treat subclinical micrometastatic disease and increase the rate of downstaging, therefore increasing the likelihood of successful surgical resection. The approach to LABC has evolved considerably over the years, and preoperative therapy is now the cornerstone of treatment. 1,2 Locally advanced breast cancer (LABC), which accounts for 6% to 10% of new cases of breast cancer, generally is associated with a poor prognosis and may be inoperable at presentation or require mastectomy.
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