Macau Society of Clinical Oncology

Preoperative Consideration and Benefits of Neoadjuvant Therapy in HER2+ BC


Thank your for your time!

Q1. What is the association of pathological complete response (PCR) and patient outcomes?

In the study “Pathological complete response in neoadjuvant treatment of breast cancer”, the Collaborative Trials in Neoadjuvant Breast Cancer group demonstrated that pCR defined as no residual invasive cancer in the breast and axillary nodes with presence or absence of in situ cancer (ypT0/is ypN0 or ypT0 ypN0) provided a better association with improved outcomes compared to eradication of invasive tumor from the breast alone (ypT0/is).

(Ann Surg Oncol, 2015 May;22(5):1441-6. doi: 10.1245/s10434-015-4404-8. Epub 2015 Mar 2)

Q2. What are the key findings of adjuvant trastuzumab emtansine (T-DM1) for residual invasive HER2-Positive Breast Cancer?

In the study “Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer”, the estimated percentages of patients who would be free of invasive disease at 3 years were 88.3% in the T-DM1 group and 77.0% in the trastuzumab group .Invasive disease–free survival, the primary end point, was significantly higher among patients who received T-DM1 than among those who received trastuzumab (hazard ratio, 0.50; 95% confidence interval [CI], 0.39 to 0.64; P<0.001).  A subgroup analysis of invasive disease–free survival revealed a consistent benefit of T-DM1 across stratification cohorts and other subgroups (Figure 2), including patients with hormone-receptor–positive or hormone-receptor–negative disease, patients with positive or negative pathological nodal status after neoadjuvant therapy, and patients with either no residual invasive primary disease or residual primary disease of 1 cm or less in the breast.

(N Engl J Med 2019; 380:617-628)

Q3. What type of HER2 positive breast cancer patient should receive neoadjuvant chemotherapy (NAC)?

Current, ESMO guidelines recommend a neoadjuvant approach should be preferred in subtypes

highly sensitive to chemotherapy, such as triple-negative and HER2-positive, in tumours >2 cm [II, A] and/or a positive axilla.

Q4. Which imaging modalities should be used to monitor response after completion of neoadjuvant therapy?

Current, ESMO guidelines recommend breast mammogram, ultrasound of the breast and lymph nodes, and MRI for all patients prior to and following neoadjuvant systemic therapy to assess disease involvement and evaluate response to therapy

Q5. What would be the benefits of neoadjuvant chemotherapy?

Referring to speaker slide:  at time 44:00