Background: Neoadjuvant systemic therapy is the preferred treatment approach for stage II–III HER2-positive breast cancer (BC). Real-life data comparing regimens with or without anthracyclines combined with two HER2 drugs is lacking. We compared the efficacy and toxicity of two commonly used regimens. Methods: Retrospective data were collected on patients newly diagnosed with clinical stage II–III HER2-positive BC and treated at Sheba Medical Center, Israel, between September 2017 and June 2022 with either neoadjuvant DCbHP (docetaxel, carboplatin, trastuzumab, pertuzumab) or ACTHP (doxorubicin, cyclophosphamide, paclitaxel trastuzumab pertuzumab). PCR (pathological complete response) (ypT0/isN0) was evaluated in both cohorts and according to HER2 immunohistochemistry (IHC) staining (3+ or 2+ and fluorescence in situ hybridization [FISH] positive), estrogen receptor (ER), tumor size and nodal status. The toxicity indices evaluated were reductions in left ventricle ejection fraction (LVEF), dose reductions, hospitalizations and febrile neutropenia. Results: Here, 106 received ACTHP and 73 received DCbHP. Median age at diagnosis, ER status, HER2 IHC (2+/FISH pos or 3+) and nodal status were balanced. PCR occurred in 63.1% of patients, 67.0% and 57.5% in the ACTHP and DCbHP groups, respectively (p= 0.129). In patients with HER2 3+ IHC, pCR rates were significantly better with the ACTHP regimen than with DCbHP (83% vs. 62.9%,p< 0.039). No difference was observed among patients with HER2 +2 IHC FISH pos. Symptomatic LVEF decrease was observed in seven patients (6.6%) receiving ACTHP vs. none (0%) receiving DCbHP (p< 0.001). Conclusions: PCR rates were similar overall between ACTHP and DCbHP; however, in the HER2 3+ subgroup, ACTHP demonstrated increased efficacy. DCbHP was significantly less cardiotoxic.
背景：新辅助全身治疗是II-III期HER2阳性乳腺癌（BC）的首选治疗方法。目前缺乏比较含或不含蒽环类药物联合两种HER2靶向药物的真实世界数据。本研究比较了两种常用方案的疗效与毒性。 方法：回顾性收集2017年9月至2022年6月在以色列Sheba医疗中心新诊断为临床II-III期HER2阳性BC患者的资料，治疗方案为新辅助DCbHP（多西他赛、卡铂、曲妥珠单抗、帕妥珠单抗）或ACTHP（多柔比星、环磷酰胺、紫杉醇、曲妥珠单抗、帕妥珠单抗）。评估两组患者的病理完全缓解（pCR）（ypT0/isN0），并根据HER2免疫组化（IHC）染色（3+或2+且荧光原位杂交[FISH]阳性）、雌激素受体（ER）状态、肿瘤大小及淋巴结状态进行分层分析。评估的毒性指标包括左心室射血分数（LVEF）下降、剂量减少、住院及发热性中性粒细胞减少。 结果：共纳入106例接受ACTHP治疗和73例接受DCbHP治疗的患者。诊断时的中位年龄、ER状态、HER2 IHC（2+/FISH阳性或3+）及淋巴结状态均保持平衡。总体pCR率为63.1%，其中ACTHP组为67.0%，DCbHP组为57.5%（p=0.129）。在HER2 IHC 3+患者中，ACTHP方案的pCR率显著优于DCbHP方案（83% vs. 62.9%，p<0.039）。在HER2 IHC 2+且FISH阳性患者中未观察到差异。ACTHP组有7例患者（6.6%）出现症状性LVEF下降，而DCbHP组无一例发生（0%）（p<0.001）。 结论：ACTHP与DCbHP方案的总体pCR率相近；但在HER2 3+亚组中，ACTHP显示出更优疗效。DCbHP方案的心脏毒性显著更低。
肿瘤(癌症)患者之家