New Certificate of Liuye Knife: Her2 + New Breast Cancer New Assistance or "Exemptation of Chemotherapy"

*For medical professionals for reading reference

Professor Li Junjie of Fudan University Cancer Hospital explained!

For early breast cancer patients, the world still faces the two major problems that "how to avoid chemotherapy" and "which types of people can really benefit from chemotherapy, targeted or endocrine therapy".

Twozumab (T) + Puffyzumab (P) Double -resistance and new assisted treatment after using antibody coupling drugs (ADC) Eunmezuzumab treatment, which improves HER2 + early breast cancer, improved significantly Essence In the context of good overall prognosis, whether HER2 + early breast cancer can be further treated with staircases has become a focus of clinical attention.

A few days ago, The Lancet Oncology magazine published the five-year results of WSG-Adapt-Her2+/HR-. Strategy. Professor Li Junjie Li Junjie, an affiliated to the Cancer Hospital of Fudan University in the medical community, shared his academic insights on the research.

Study and publish screenshots

Highly forward -looking, innovative

The study was a multi-center open label random II study initiated by researchers, incorporated into 134 patients ≥ 18 years, and the organizational science confirmed unilateral primary inflammatory non-inflammatory Her2 +/HR-early breast cancer. ECOG was 0/1 Or Karnofsky at least 80%. Patients are randomly allocated at 5: 2 to T (load 8 mg/kg, then 6 mg/kg every 3 weeks)+p (load 840 mg, then 420 mg every 3 weeks (n = 92) or T+P+ Pucin (80 mg/m2 per week, 12 weeks of treatment) group (n = 42).

The five -year survival ending of the patient was studied and found that there was no statistical difference between the data between the P+T group and the P+T+paclitaxel group, and the patient's survival ending was similar.

Survival without infiltration disease (IDFS): 98% vs 87% (P = 0.15);

No recurring survival (RFS) rate: 98% vs 89% (P = 0.25);

No local recurrence (LRFS) rate: 100% vs 95% (P = 0.43);

No distant transfer survival (DMFS) rate: 98% vs 92% (p = 0.36);

Total survival (OS) rate: 98% VS 94% (P = 0.43).

In addition to the recurrence rate, no event survival (EFS) and OS, which are commonly used to evaluate the effectiveness of treatment effectiveness, pathological response (including the PCR rate) is also a useful effect assessment indicator for patients with neo -assisted therapy.

After 12 weeks of new assisted therapy, 31 patients with P + T (34.4%) were PCR, P + T + paclitaxel group 38 patients (90.5%) patients reached PCR.

Among the whole intentional treatment crowd, 13 IDFS incidents occurred, 12 cases of P + T group, 1 of patients with PCR patients, 10 of Non-PCR patients, and 1 of P + T + paclitaxel group PCR patients.

When talking about the highlights of this study, Professor Li Junjie said: "At the level of assisting therapy, anti -HER2 treatment after surgery is performed. It can be used as auxiliary therapy for staircases, but at this time, auxiliary therapy is blind, and it cannot really screen people with sensitive HER2 treatment. "

This research can be published in the Lancet Oncology of the Lancet Oncology, which is also in its:

The concept is consistent with the current "staircase" treatment standard;

Patients in the group have a multi -group learning information, which can further prompt people who benefit from the dual -target treatment plan;

It was followed up for 59.9 months (IQR: 53.4-61.4). The results were prompted to use anti-HER2 treatment new-aided therapy strategies that did not contain chemotherapy to achieve pathological relief (PCR) and used chemotherapy combined with dual target therapy to reach PCR Patients' prognosis is similar.

Different stages of disease continue to be deeply cultivated

What impact will the results of the five years of research come out? Professor Li Junjie pointed out: "The clinical study of small samples can bring forward -looking information prompts or assumptions to clinical practice. In the later period, a larger sample volume of clinical studies must be verified."

"It is worth noting that this study is not blindly selected all HER2 + patients for staircase treatment, but to screen the people who really benefit from the treatment of anti-HER2 treatment based on the result of immunohistochemistry, and for HR-with low tolerance of chemotherapy Or in clinical practice, HER2 + patients who refuse chemotherapy are treated with stairs. "Professor Li Junjie introduced it.

In the context of the good prognosis of HER2 + breast cancer patients, what other clinical problems need to be solved? Professor Li Junjie conducted a comprehensive analysis from the early and late stages of the disease.

In the early stage of the disease, it is necessary to explore individualized lifting ladder plans. For example, patients with very sensitive patients are selected for ladder reduction treatment, and a lifting of ladder treatment for patients with unsightly treatment of existing anti -HER2 treatment.

In the advanced stage of the disease, HER2 + patients with recurrence progress need to adopt an updated and more effective treatment strategy to reverse HER2 drug resistance. At present, the heavy ADC drug T-DXD has shown a good treatment effect. I have received a new indication certificate for the non -removal or metastatic HER2 positive adult breast cancer patients with more than one or more anti -HER2 drug treatment. How to enter the first -line treatment qualification? In addition, after the failure of ADC drug treatment, how to choose other treatment methods? These are the focus of clinical practice. Aiming at HER2 + brain metastases, how to perform activity brain metastases and asymptomatic brain metastases, further reasonable selection of individual chemotherapy strategies for systematic treatment and local treatment is also a clinical realistic issue that needs to be explored.

At present, the Multi-disciplinary team of breast cancer at the Fudan University Cancer Hospital is actively carrying out different stages of HER2 + breast cancer in different stages of HER2 + breast cancer in different stages of patients including neo-assisted therapy and poor treatment. The clinical trials of international multi -centers, domestic or Asia -Pacific centers bring the gospel to more patients.

Expert Introduction

Professor Li Junjie

Fudan University Cancer Hospital Deputy Chief Physician, Ph.D. in Medicine, Dao Dao.

He is currently the assistant director of the department, the director of the Pudong Ward, and the department of teaching.

In 2008, he graduated from the seven -year major of clinical medicine at Fudan University. He went to the Cancer Center of the General Hospital of Massachusetts to conduct a study of clinical specialties in breast cancer. Test, published 15 SCI papers, with a maximum impact factor of 33 points. Prested a project on the National Nature.

Currently serving as youth experts of the Breast Cancer Professional Committee of the China Anti -Cancer Association, youth experts of the Breast Oncology Group of the Chinese Medical Association, a member of the Standing Committee of the Shanghai Anti -Cancer Association Breast Cancer Professional Committee, Secretary of the China Anti -Cancer Association International Medical Exchange Committee, the Beijing Cancer Prevention Society The deputy chairman of the Breast Youth Committee, the young and middle -aged editorial board of the Chinese breast disease magazine.

references:

[1] Nitz U, Gluz O, Graeser M, Christgen M, Kuemmel S, Grischke Em, Braun M, Augustin D, Potenberg J, Krauss K, Schumacher C, Forsstbauer H, Reimer T, Stefek A, Fischer H, Pelz , Zu Eulenburg C, Kates R, Wuerstlein R, Kreipe HH, Harbeck N; WSG-ADAPT investigators. De-escalated neoadjuvant pertuzumab plus trastuzumab therapy with or without weekly paclitaxel in HER2-positive, hormone receptor-negative, early breast cancer (WSG -ADAPT-HER2+/HR-): Survival outComes from a Multicentre, Open-Label, RANDOMISED, PHASE 2 TRIAL. 2022 May; 23 (5): 625-635.doi: 10.1016/s1470-2045 (22) 00159-0.

https://www.thelant.com/journals/lanonc/article/piis1470-2045 (2)00159-0/FullText

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

Author of this article: Olaf, strong

Review of this article: Li Junjie, Affiliated to Fudan University Cancer Hospital

Editor in charge: Sweet

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