Effect Of Two Neoadjuvant Chemotherapy Regimens Combined With Dual-target On HER-2 Positive Breast Cancer And Its Related Factors Analysis

Objective: To investigate the effects of two different neoadjuvant chemotherapy regimens with anthracycline or taxane as the main chemotherapeutic drugs,namely epirubicin,cyclophosphamide followed by docetaxel(AC-T)or docetaxel,carboplatin(TCb),combined with trastuzumab(H)and pertuzumab(P)on pathological complete response(p CR)rate,objective response rate(ORR)and safety of human epidermal growth factor receptor-2 positive breast cancer after neoadjuvant therapy,and to analyze the influencing factors of p CR rate.Methods: The clinicopathological data of HER-2 positive breast cancer patients who underwent NAT with AC-THP or TCb HP in the Breast Disease Treatment Center of the Affiliated Hospital of Southwest Medical University from May 2019 to May 2021 were retrospectively collected.The primary endpoint was to compare the difference in total pathological complete response rate(tp CR(yp T0/tis,yp N0)),ORR and adverse reactions between the two chemotherapy regimens combined with HP dual-target therapy.The secondaryendpoint was to observe the difference between the breast pathological complete response(bp CR(yp T0/tis))rate,axillary pathological complete response(ap CR(yp N0))rate,clinical complete response(CR)rate and clinical partial response(PR)rate and to analyze the factors affecting the tp CR rate.Results: A total of 128 neoadjuvant patients using two target chemotherapy regimens combined with HP dual-target were included in the analysis,of which 75 patients used the TCb HP regimen and 53 patients used the AC-THP regimen.The baseline characteristics of the two groups were similar,but the frequency of albumin-bound paclitaxel was higher in patients with TCb HP regimen(χ2=4.400,P=0.036).The total tp CR rate of 128 patients was 60.9%,of which TCb HP was 62.7% and AC-THP was 58.5%(χ2=0.228,P=0.172).The total bp CR rate was 64.1%,TCb HP was 65.3%,and AC-THP was 62.3%(χ2=0.127,P=0.721).The total ap CR rate was 70.3%,TCb HP was 78.7%,and AC-THP was 58.5%(χ2=6.009,P=0.023).In terms of clinical efficacy indicators,the total ORR of the two regimens was 92.2%,with 93.3% for TCb HP and 90.6% for AC-THP(P=0.740);the total CCR rate was 45.3%,with 50.7% for TCb HP and 37.7% for AC-THP(χ2=2.095,P=0.148);the total CPR rate was 46.9%,with TCb HP 42.7% and AC-THP was 52.8%(χ2=1.288,P=0.256).Univariate analysis by chi-square test showed that hormone receptor(HR)status,estrogen receptor(ER)expression,progesterone receptor(PR)expression,HER-2 status,axillary lymph node status,clinical stage,and taxane type were related factors affecting tp CR rate.Binary logistic regression analysiswas used to bring the factors with P<0.05 in univariate analysis into multivariate analysis,and it was found that ER expression,HER-2 status,and axillary lymph node status were independent factors for predicting tp CR rate.In terms of adverse reactions,the incidence of grade 3~4 thrombocytopenia and anemia in the TCb HP regimen was higher than that in the AC-THP regimen(all P<0.001),and there was no significant difference in other adverse reactions.Conclusion: In this study,the tp CR rate,ap CR rate,and bp CR rate of TCb HP were higher than those of AC-THP in the comparison of the efficacy of two different chemotherapy regimens combined with dual-target NAT for HER-2 positive breast cancer,but significant differences in efficacy were seen only in ap CR rate.No significant differences were seen between the two regimens in clinical efficacy indicators such as ORR,CCR and CPR.In addition,different degrees of hematological toxicity,liver function damage and left ventricular ejection fraction(LVEF)decline can be observed in all patients using both regimens.There was no significant difference between the two regimens in terms of liver function damage and LVEF decline,but patients using the TCb HP regimen had higher grade 3~4 hematological toxicity.According to the results of multivariate analysis,ER-negative,HER-2(3+),and clinical axillary lymph node negative patients had higher tp CR rates.This study is a small sample,single-center retrospective analysis,and lacks survival data.More large-scale clinical prospective experiments are needed to confirm the results.