학술논문
Impact of Neoadjuvant Paclitaxel/Trastuzumab/Pertuzumab on Breast Tumor Downsizing or Patients with HER2+ Breast Cancer: Single-Arm Prospective Clinical Trial.
Document Type
Article
Author
Weiss, Anna; Tianyu Li; Desai, Neelam V.; Tung, Nadine M.; Poorvu, Philip D.; Partridge, Ann H.; Nakhlis, Faina; Dominici, Laura; Sinclair, Natalie; Spring, Laura M.; Faggen, Meredith; Constantine, Michael; Krop, Ian E.; DeMeo, Michelle; Wrabel, Eileen; Alberti, Jillian; Chikarmane, Sona; Tayob, Nabihah; King, Tari A.; Tolaney, Sara M.
Source
Subject
*BREAST ultrasound
*KRUSKAL-Wallis Test
*CLINICAL trials
*ONCOGENES
*AGE distribution
*MONOCLONAL antibodies
*ANTINEOPLASTIC agents
*MAMMOGRAMS
*MAGNETIC resonance imaging
*TREATMENT effectiveness
*TUMOR classification
*RESEARCH funding
*CHI-squared test
*COMBINED modality therapy
*PACLITAXEL
*DATA analysis software
*BREAST tumors
*LONGITUDINAL method
*PHARMACODYNAMICS
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Language
ISSN
2563-9021
Abstract
BACKGROUND: The impact of abbreviated neoadjuvant regimens for HER2+ breast cancer on rates of breast conservation therapy (BCT) is unclear. We aimed to determine BCT rates in a single-arm prospective trial of neoadjuvant paclitaxel/trastuzumab/pertuzumab (THP) in patients with stage II or III HER2+ breast cancer. STUDY DESIGN: BCT eligibility was prospectively recorded before and after THP. Pre- and posttreatment mammogram and breast ultrasound were required; breast MRI was encouraged. Patients with a large tumor to breast size ratio were eligible for downsizing. Multifocal/multicentric tumors, extensive calcifications, and contraindications to radiation were considered BCT contraindications. RESULTS: Overall, 92 patients who received neoadjuvant THP on trial were included. At presentation, 39 (42.4%) were considered eligible for BCT and 53 (57.6%) were not. BCT-eligible patients were older (median 54 vs 47 years, respectively; p = 0.006) and had smaller tumors by palpation (median 2.5 vs 3 cm, respectively; p = 0.004). Of 53 BCT-ineligible patients, 28 were candidates for tumor downsizing, whereas 25 had contraindications to BCT. Overall, 51 (55.4%) patients underwent BCT. Of the 28 patients who were candidates for downsizing, 22 (78.6%) became BCT-eligible after THP and 18 of 22 (81.8%) underwent BCT. In total, 44 of 92 (47.8%) patients experienced breast pathologic complete response (ypT0), including 11 of 25 (44.0%) patients with BCT contraindications at presentation. CONCLUSIONS: De-escalated neoadjuvant systemic therapy led to high BCT rates in this cohort. The impact of de-escalated systemic therapy on local therapy and outcomes in early stage HER2+ breast cancer warrants further investigation. [ABSTRACT FROM AUTHOR]