Response Assessment to Neoadjuvant Treatment with Dual HER2 Blocker in HER2 positive Early and Locally Advanced Breast Cancer

Asima Bashir; Muhammad  Nadeem; Maimoona  Nasir; Mussavir Hussain  Bangash; Rahimullah  Khattak; Amjad  Khan

doi:10.51253/pafmj.v76iSUPPL-5.10388

Authors

Asima Bashir Department of Medical Oncology, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Muhammad Nadeem Department of Medical Oncology, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Maimoona Nasir Department of Medical Oncology, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Mussavir Hussain Bangash Department of Medical Oncology, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Rahimullah Khattak Department of Medical Oncology, Khyber Girls Medical College, Peshawar Pakistan
Amjad Khan Department of Medical Oncology, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-5.10388

Keywords:

Breast Cancer, Cancer, HER2 Blockade, Pathological Response

Abstract

Objective: To analyze response assessment to dual HER2 blockade in HER2 positive early and advanced breast cancer and to identify factors associated with partial response among the study participants

Study Design: Quasi-experimental study.

Place and Duration of Study: Oncology Department, Combined Military Hospital Rawalpindi, Pakistan, from Sep 2022 to Apr 2023.

Methodology: One hundred and eighty ladies with early and advanced breast cancer who were HER2 neu positive and were given dual HER2 blockade treatment before surgical resection of the tumor. Response was assessed after the surgery on surgical specimen and classed as partial or complete response. Relevant clinical factors were associated with presence of partial response among the women included in the study.

Results: Mean age of the patients was 45.56±9.91 years. Out of 180 patients, 116(32.9%) had complete pathological response while 64(25.6%) had partial response to the neo-adjuvant therapy combined with dual HER2 blockade. Having T1-2N1 disease, ER PR negative and HER2 positive disease, and not having interruptions in treatment due to neutropenia or cardiotoxicity were found associated with complete pathological response to neo-adjuvant medications combined with dual HER2 blockade (p-value<0.05).

Conclusion: Complete pathological response was seen in the majority of patients included in our study. Having T1-2N1 disease, ER PR negative and HER2 positive disease, and not having interruptions in treatment due to neutropenia or cardiotoxicity were factors associated with complete pathological response in our study participants.

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References

1. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics 2021. CA Cancer J Clin 2021; 71(1): 7-33.

https://doi.org/10.3322/caac.21654

2. Alkabban FM, Ferguson T. Breast Cancer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2021.

https://www.ncbi.nlm.nih.gov/books/NBK482286/

3. Lüftner D, Schneeweiss A, Hartkopf AD, Muller V, Wockel A, Janni W, et al. Update Breast Cancer 2020 Part 2 - Advanced Breast Cancer: New Treatments and Implementation of Therapies with Companion Diagnostics. Geburtshilfe Frauenheilkd 2020; 80(4): 391-398.

https://doi.org/10.1055/a-1111-8775

4. Maajani K, Jalali A, Alipour S, Khodadost M, Tohidinik HR, Yazdani K. The Global and Regional Survival Rate of Women With Breast Cancer: A Systematic Review and Meta-analysis. Clin Breast Cancer 2019; 19(3): 165-177.

https://doi.org/10.1016/j.clbc.2019.01.006

5. Shaaban AM, Kaur T, Provenzano E. HER2-low breast cancer—current knowledge and future directions. Medicina 2025; 61(4): 644. https://doi.org/10.3390/medicina61040644

6. Li X, Zhang X, Yin S, Nie J. Challenges and prospects in HER2-positive breast cancer-targeted therapy. Crit Rev Oncol/Hematol 2025; 207: 104624.

https://doi.org/10.1016/j.critrevonc.2025.104624

7. Pop L, Suciu ID, Ionescu O, Ionescu P, Toader OD. The Dual Blockade in the Neoadjuvant Setting of HER-2 Positive Early-Stage Breast Cancer. J Med Life 2019; 12(4): 329-331.

https://doi.org/10.25122/jml-2019-0115

8. Cha C, Ahn SG, Kim D. Axillary response according to neoadjuvant single or dual human epidermal growth factor receptor 2 (HER2) blockade in clinically node-positive, HER2-positive breast cancer. Int J Cancer 2021; 149(8): 1585-1592.

https://doi.org/10.1002/ijc.33726

9. Wang C, Chen J, Xu X. Dual HER2 Blockade in Neoadjuvant Treatment of HER2+ Breast Cancer: A Meta-Analysis and Review. Technol Cancer Res Treat 2020; 19: 1533033820960721.

https://doi.org/10.1177/1533033820960721

10. Sheikh F, Nazir A, Yasmeen S, Badar F, Ahmad U, Siddiqui N. Pathologic Complete Response in HER2-Positive Breast Cancer Patients Receiving Trastuzumab in Neoadjuvant Setting. J Coll Physicians Surg Pak 2019; 29(2): 159-163.

https://doi.org/10.29271/jcpsp.2019.02.159

11. Wöckel A, Albert US, Janni W, Scharl A, Kreienberg R, Stüber T. The Screening, Diagnosis, Treatment, and Follow-Up of Breast Cancer. Dtsch Arztebl Int 2018; 115(18): 316-323.

https://doi.org/10.3238/arztebl.2018.0316

12. Pernaut C, Lopez F, Ciruelos E. Standard Neoadjuvant Treatment in Early/Locally Advanced Breast Cancer. Breast Care 2018; 13(4): 244-249.

https://doi.org/10.1159/000491759

13. Dowling GP, Keelan S, Toomey S, Daly GR, Hennessy BT, Hill ADK. Review of the status of neoadjuvant therapy in HER2-positive breast cancer. Front Oncol 2023; 13(3): 1066007.

https//doi.org/10.3389/fonc.2023.1066007

14. Qiao W, Guo W, Liu Q, Guo X, Deng M. Pathological complete response and prognosis after neoadjuvant chemotherapy in patients with HER2-low breast cancer. Ann Diagn Pathol 2023; 64(2): 152125.

https://doi.org/10.1016/j.anndiagpath.2023.152125

15. Chen S, Liang Y, Feng Z, Wang M. Efficacy and safety of HER2 inhibitors in combination with or without pertuzumab for HER2-positive breast cancer: a systematic review and meta-analysis. BMC Cancer 2019; 19(1): 973.

https://doi.org/10.1186/s12885-019-6132-0

16. Thill M, Wimberger P, Grafe A, Klare P, Luedtke-Heckenkamp K, Reichert D, et al. Dual HER2 blockade with pertuzumab (P) and trastuzumab (T) in patients with HER2-positive metastatic breast cancer (mBC) relapsing after adjuvant treatment with T: results from a German non-interventional study (NIS) HELENA (NCT01777958). Breast Cancer Res Treat 2022; 196(2): 311-321.

https://doi.org/10.1007/s10549-022-06710-4

17. Hurvitz SA, Martin M, Symmans WF, Jung KH, Hunag CS, Thompson AM, et al. Neoadjuvant trastuzumab, pertuzumab, and chemotherapy versus trastuzumab emtansine plus pertuzumab in patients with HER2-positive breast cancer (KRISTINE): a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol 2018; 19(1): 115-126.

https://doi.org/10.1016/S1470-2045(17)30716-7

18. Tan AR, Im SA, Mattar A, Colomer R, Stroyakovskii D, Nowecki Z, et al. Fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection plus chemotherapy in HER2-positive early breast cancer (FeDeriCa): a randomised, open-label, multicentre, non-inferiority, phase 3 study. Lancet Oncol 2021; 22(1): 85-97.

https://doi.org/10.1016/S1470-2045(20)30536-2