What is wrong with this picture? only 25% of ER+her2+s given neoadj chemo+herceptin

[Lani]

achieve pCRs vs 63% of ER-her2+s

In most studies pCRs are correlated with clinical prognosis (RFS,OS) and are considered surrogates for recurrence free and overall survival in the opinion of many--although in this one it was not significant

Why aren't they more aggressive in looking at combinations of targeted therapies for ER+her2+s (cost certainly involved). Results w AIs+herceptin
not that impressive either. Here you would seem to have a group where determining the drivers of the cancer could help you pick the best combination
(since chemo not that helpful)

Numbers here were small--only 5 patients w er+/pr+ her2+ bc out of 161. Normally "triple positives" make up about 10=12% of breast cancer eg about half of her2+s which make up 20-25%

This is another example of how neoadjuvant treatment gives you answers ie, pCR or no pCR, but that information is NOT YET being acted upon. And here again, they show that pCR is more indicative of eventual prognosis in triple negative and er-her2+ bc, but not in ER+her2+ bc.

We do not yet know what optimal treatment is. It just seems they move slowly
from treating all breast cancer as if it were one entity to treating her2+ breast cancer as if it were one entity.

The good news is ... we are getting there bit by bit



Breast Cancer. 2012 Oct 30. [Epub ahead of print]
Pathological responses and survival of patients with human epidermal growth factor receptor 2-positive breast cancer who received neoadjuvant chemotherapy including trastuzumab.
Ohzawa H, Sakatani T, Niki T, Yasuda Y, Hozumi Y.
Source
Department of Breast and General Surgery, Jichi Medical University, Shimotsuke, Japan.
Abstract
BACKGROUND:
The effectiveness of neoadjuvant chemotherapy is evaluated on the basis of pathological responses and survival outcome, because achievement of a pathological complete response (pCR) is a good predictor of long-term survival. However, few studies have assessed the survival of breast cancer patients who received neoadjuvant chemotherapy including trastuzumab.
METHODS:
The records of 161 breast cancer patients who received neoadjuvant chemotherapy between January 2006 and December 2011 were retrospectively reviewed. The patients were categorized into 4 subgroups on the basis of the status of the estrogen receptor (ER), the progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2). HER2-positive patients received trastuzumab-based regimens. Pathological responses and survival were analyzed on the basis of breast cancer subtypes.
RESULTS:
The pCR results obtained were: luminal A and B (ER and/or PR-positive, HER2-negative), 6.3 % (5/79 cases); luminal-HER2 hybrid (ER and/or PR-positive, HER2-positive), 25.0 % (5/20 cases); HER2-enriched (ER and PR-negative, HER2-positive), 63.0 % (17/27 cases); and triple-negative (ER and PR-negative, HER2-negative), 25.7 % (9/35 cases). Achievement of pCR was a good predictor of disease-free survival in the HER2-enriched group. Overall survival of patients with pCR was slightly, but not significantly, better in the HER2-enriched and triple-negative subgroups.
CONCLUSION:
Responses and survival after neoadjuvant chemotherapy including trastuzumab of patients with HER2-positive tumors differed among disease subtypes. Our findings suggest that disease subtype is an important determinant of the efficacy of neoadjuvant chemotherapy.
PMID: 23108629