New progress of HER2+breast cancer and brain metastases can change the clinical pattern?| 2022 ESMO

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2022 ESMO Conference -new progress of Her2+breast cancer treatment plan

HER2 -positive breast cancer accounts for about 15%to 20%of breast malignant tumors, and has the characteristics of strong invasion, high recurrence rate, poor prognosis, etc. [1]. How to formulate a better treatment plan to significantly reduce the recurrence rate of such patients and extend the survival of HER2 -positive patients.

In 2022, the European Cancer Internal Science Association (ESMO Conference) was successfully held in Paris from September 9th to September 13th. The conference reported a number of heavy cutting -edge results about breast cancer. The three important studies, the main points of the report are as follows:

Refine the classification of breast cancer, explore the candidate plan for personalized therapy

确ALTTO: Determine HER2 -positive breast cancer subcontraction related to the prognosis of the auxiliary Tuskuzumab

Summary number: 139Mo

figure 1

The ALTTO TRIAL in the report is a forward -looking, random, open label, and multi -centered phase III clinical trial. This study is mainly to determine the Asian group related to patients who received the prognosis of patients in the phase III ALTTO test. feature.

■ Research method:

The method of using cases (1: 2) Choose 134 patients who transfer recurrence from the Quchuzumab group and 268 patients who have no distant transfer recurrence in the study;

Calculate the PAM50 subtypes with an absolute inner molecular type (AIMS), and use the Cox regression model and Kaplan-Meier's survival curve for long-term uncompromising survival status (DRFS) analysis.

■ Result:

Compared with the entire Twozumab group, the tumor size in the case control group is> 2cm, the proportion of patients with positive lymph nodes and G3 tumors is higher;

Select the gene related to DRFS for NMF analysis to obtain 4 factors; the K-average cluster determines 4 groups with different prognosis, namely the immune enrichment group (n = 69; 91%, 5 years of DRFS), metabolic wealth Collection group (n = 87; 51%, 5 years of DRFS), matrix enrichment group (n = 76; 58%, 5 years of DRFS) and hormone receptor positive group (n = 154; 78%5 years of DRFS) Among them, hormone receptor-positive enrichment groups are divided into HER2-E (n = 91; 72%, 5 years of DRFS) and non-HER2-E tumors (mainly luminal A/B) (n = 63; 87%, 5, 5, 5, 5, 5, 5, 5, 5, 5, 5, 5, 5, 5, 5, 5 DRFS).

■ Conclusion:

Through a method of monitoring from top to bottom, four biological -driven clusters are found in HER2 -positive breast cancer, which can be integrated with PAM50. The research results support the evaluation method in the Luminal group and immune enrichment sub -groups, and in the high -risk population, the single -risk population shows a good prognosis. But the conclusion still needs to be further verified.

T-DXD is used to treat active brain metastasis endless potential

疗T-DXD Treatment HER2-positive breast cancer with active brain metastases of patients' life and neurop awareness: A forward-looking, single-arm, II phase TUXEDO-1 test second point analysis

Summary number: 281MO

figure 2

As high as 15%of metastatic breast cancer patients will eventually develop into brain metastases in their respective course, of which the metastasis rate of three -negative breast cancer and HER2 -positive breast cancer [3]. Patients with brain metastases are usually accompanied by the decline in neural cognitive function, which further leads to a decline in quality of life.

Maintaining the quality of life (QOL) and neural cognition is a major goal of HER2 -positive breast cancer with brain metastasis (BM). TUXEDO-1 research explores the effects of T-DXD's QOL and neuropiacators on HER2-positive breast cancer with BM patients during treatment.

■ Research method:

Tuxedo-1 adult HER2-positive breast cancer patients who do not need to be treated with local treatment immediately are administered every 3 weeks until the disease progresses and unacceptable adverse adverse adverse adequate doses of T-DXD. Response or the patient's request to withdraw;

The secondary end of the test is QOL. Patients need to complete the EORTC QLQ-C30 questionnaire each time every 9 weeks and the following 9 weeks. The final assessment is conducted in the first survival follow-up of the three months after the treatment.

■ Result:

A total of 15 patients were incorporated, and all patients received at least one dose of T-DXD treatment;

During T-DXD treatment, the global QOL of QLQ-C30 (the slope of each follow-up is -0.13, P = 0.953), the body (0.52, P = 0.363), emotion (-0.24, P = 0.835), and cognitive functions Scores (-0.79, P = 0.429) remain unchanged.

■ Conclusion:

TUXEDO-1 shows that during the T-DXD treatment in patients with HER2-positive breast cancer BM, QOL and neural cognitive functions were maintained. The test data supports the first-line system treatment of T-DXD for active BM patients.

HER2DX may become a prediction tool for the prognosis of HER2+breast cancer

Analysis of 试Perelisa test: Her2 -positive/hormone receptor (HER2+/HR+) breast cancer patient HER2DX genome test summary number of HER2 positive/hro+hormone receptor (HER2+/HR+) of Tushuzumab and Puffyzumuke. 140Mo

image 3

In the early HER2 positive breast cancer, the upgrade or downgrade of systemic treatment has always been a controversial topic. HER2DX combines clinical data (such as tumor size and lymph nodes) and immune response, tumor division, tumor cell proliferation, and HER2 17Q12-21 biological information (including ERBB2 gene) of the expression of chromosome amplification subclaseer to help identify clinical clinical clinical do not need to do (New) Low -risk patients with assisted chemotherapy [2].

The PERELISA test in the newspaper evaluates the ability of HER2DX prediction HER2+/HR+breast cancer, and the effectiveness of new assisted treatment schemes of chemotherapy (CT).

■ Research method:

Her2+/HR+breast cancer patients with newly diagnosed the postmenopausal diagnosis will conduct HER2DX evaluation of the FFPE tumor sample before treatment; first receive 2 weeks of incezole (L) treatment, and then biopsy again to evaluate KI67; endocrine therapy sensitive tumor patients ( EST) (that is, the relative reduction of Ki67 in the second week of Ki67 continued to receive L and started T+P treatment of 5 cycles;

HER2DX provides 3 kinds of information, namely Her2DX recurrence risk scores, Her2DX PCR scores, and Her2DX ERBB2 scores to predict the ability of EST patients to completely alleviate (PCR).

■ Result:

Eventually included 40 patients with EST and conducted HER2DX evaluation. The PCR rate of EST patients is 22.5%. The Her2DX PCR score of this group is positively correlated with the probability of EST patients (P = 0.012; AUC = 0.80), and the PCR rate of low, medium, and high HER2DX PCR rating group is 8.0%, respectively. (2/25), 43.0%(6/14) and 100.0%(1/1);

Her2dx ERBB2 scores are positively correlated with the probability of obtaining PCR patients in EST patients (P = 0.004; AUC = 0.88), and independent of HER2 level (2+vs 3+), low, medium, and high HER2DX Erbb2 rating group's PCR rate is 0.0, respectively. %(0/12), 8.3%(1/12) and 50.0%(8/16).

■ Conclusion:

HER2DX can predict the early HER2+/HR+breast cancer patients with neo -assisted treatment of endocrine sensitivity and PCR after T+P+L. In this case, HER2DX can help adjust the whole body treatment plan.

The treatment of HER2 -positive breast cancer is still challenging. How to optimize the treatment of drugs and personalized treatment in the future will become the focus of clinical attention. A number of studies are in progress, and it is expected to bring more benefits to the treatment of HER2 -positive breast cancer patients.

references:

[1] Nader-Marta G, Martins-Branco D, de azambuja e.how we treat patients with metastatic her2-positive breaker.esmo open.2022 feb; 7 (1): 100343. 100343. 100343. 100343. 100343.

[2]Prat A,Guarneri V,ParéL,et al.A multivariable prognostic score to guide systemic therapy in early-stage HER2-positive breast cancer:a retrospective study with an external evaluation.Lancet Oncol.2020 Nov;21(11) : 1455-1464.

[3] Sanna, G.et Al.Brain Metastases in Patients with Advanced Breast Cancer.anticancer Res.27,2865–2869 (2007).

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The first release of this article: the medical world tumor channel

Author of this article: SXH

Editor in charge: Sweet

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