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Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma
Published on: May 24, 2024
What is Optimal Neoadjuvant Therapy in HER2-Positive Breast Cancer?
Daniel S Peiffer1, Caitlin Maloney2, Nan Chen1
11Section of Hematology/Oncology, Department of Internal Medicine, The University of Chicago Comprehensive Cancer Center, Chicago, IL.
Summary
Neoadjuvant HER2-targeted therapy improves outcomes for HER2-positive breast cancer. This review covers dual blockade, chemotherapy de-escalation, and biomarker-guided personalization for early-stage disease.
Area of Science:
- Oncology
- Medical Oncology
- Translational Research
Background:
- HER2-positive breast cancer (15-20% of cases) historically had poor prognosis.
- HER2-targeted therapies have significantly improved outcomes, especially in early stages.
- Neoadjuvant therapy with chemotherapy is standard for Stage II/III HER2-positive breast cancer, guiding personalized treatment via pathologic complete response.
Purpose of the Study:
- To review current evidence for neoadjuvant management of early-stage HER2-positive breast cancer.
- To discuss pivotal trials, optimization/de-escalation of chemotherapy, and chemotherapy-sparing strategies.
- To examine biomarkers, resistance mechanisms, and novel therapies for individualized treatment.
Main Methods:
- Review of pivotal clinical trials establishing dual HER2 blockade (trastuzumab, pertuzumab).
- Analysis of studies on optimizing/de-escalating chemotherapy, including taxane-only regimens and carboplatin omission.
- Evaluation of emerging data on antibody-drug conjugates, immunotherapy, biomarkers, and resistance mechanisms.
Main Results:
- Dual HER2 blockade with trastuzumab and pertuzumab is a cornerstone of neoadjuvant therapy.
- Strategies for chemotherapy de-escalation and sparing are being investigated with attention to efficacy and toxicity.
- Biomarkers (molecular, genomic, immune, ctDNA, imaging) are crucial for risk-adapted treatment strategies.
- Understanding resistance mechanisms informs novel therapeutic approaches.
Conclusions:
- A contemporary, evidence-based framework for individualized neoadjuvant treatment of early-stage HER2-positive breast cancer is provided.
- Personalized treatment strategies are evolving, incorporating biomarker data and novel therapeutic combinations.
- Continued research is essential to overcome resistance and further optimize outcomes.
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