Clinical Study Of Neoadjuvant Chemotherapy With Trastuzumab For Breast Cancer With POSITIVE HER-2

Objective: Neoadjuvant chemotherapy(NAC)for HER-2 positive breast cancer can improve the efficacy and prognosis of patients through chemotherapy combined with targeted therapy(Trastuzumab(Herceptin,H)).Currently,there are many different combinations of chemotherapy drugs in clinical practice,and there is no clear regimen with high efficacy and low toxicity.Anthracyclines and taxanes are the two cornerstones of breast cancer chemotherapy,but the clinical application of anthracyclines is limited to a certain extent due to its side effect-cardiotoxicity,especially the combination of anthracyclines and trastuzumab.Anthracyclines-Pegylated liposomal doxorubicin(PEG-LD)is recognized by clinicians for its low cardiotoxicity,but the efficacy and safety of the combined regimen with trastuzumab is still unclear.The purpose of this study was to investigate neoadjuvant chemotherapy containing doxorubicin liposomes combined with trastuzumab targeted therapy in locally advanced HER-2 positive breast cancer patients,to compare the efficacy of different chemotherapy regimens,and to briefly analyze the factors affecting the efficacy and safety.Methods: This study was analyzed retrospectively from January 2017 to December 2019 at the records of 126 cases HER-2 positive of our hospital with neoadjuvant chemotherapy.Chemotherapy patients limited prior to the start of the core needle biopsy,and pathologicall diagnosised invasive breast cancer,immunohistochemicall confirmed(HER-2 3 +)or augmentation(HER-2 2 + FISH(+)).17 cases(cycles by bead used single resistance less than 4 cycles)of the patients were ruled out does not meet the requirements,eventually into the group of 109 patients for data analysis,.According to the experimental design,109 patients were divided into three groups: ATH(doxorubicin liposomes,docetaxel,trastuzumab)group,TCb H(docetaxel,carboplatin,trastuzumab)group and AC-TH(doxorubicin liposomes,cyclophosphamide,taxa/docetaxel,trastuzumab)group.CT and MRI were used to evaluate the efficacy every 2 cycles during chemotherapy,and ECG and color doppler ultrasound were used to evaluate cardiac function every cycle.After a set period(6 to 8),all cases were performed operation.The clinical curative effect on preoperative was evaluated,and pathology curative effect was evaluated after the operation(PCR definition:,there is no invasive carcinoma in the the breast tissue and axillary lymph nodes in surgical removal specimen,but allow breast carcinoma in situ is present in primary focal elements(yp T0 / isyp N0)).Results:1.Baseline characteristics: There were no statistical differences in age,tumor stage,lymph node metastasis,ER,PR,ki-67,etc.(P > 0.05).2.Preoperative clinical efficacy evaluation: No statistical difference was found in the clinical evaluation of the efficacy of chemotherapy for breast tumors and axillary lymph nodes(P=0.190,P > 0.05).3.Postoperative pathological evaluation: The PCR status was as follows:among the 32 cases in the ATH group,19 cases reached the p CR,with a p CR rate of 59.4%(19/32);17 cases in the TCb H group,with a PCR rate of 42.5%(17/40);and 13 cases in the AC-TH group,with a p CR rate of 35.1%(13/37).The difference was not statistically significant(P=0.121,P > 0.05).However,compared with AC-TH group,the p CR rate of ATH group was statistically significant(P=0.0441,P < 0.05).4.Safety evaluation: During neoadjuvant therapy,the common side effects were: leukopenia,erythrocytopenia,thrombocytopenia,decreased hemoglobin,nausea and vomiting,and cardiac toxicity,with no statistical differences(P > 0.05).There were statistical differences in oral ulcer and hand-foot syndrome between ATH group and TCb H group(P < 0.001).In the TCb H group,there were statistically significant differences in the abnormal levels of alanine aminotransferase(The detection index of liver function)and diarrhea(P=0.001,P < 0.05).Conclusions:1.Patients with HER-2 positive breast cancer received neoadjuvant chemotherapy combined with targeted therapy,ATH(Doxorubicin liposome)regimen had a high p CR rate.2.The three regimens were well tolerated,especially with no significant difference in cardiotoxicity.3.The incidence of hand foot syndrome and oral mucositis in the regimen containing liposomes was higher.