内容紹介
Summary
Objective:We examined the therapeutic effect of adding of pertuzumab in combination with trastuzumab as neoadjuvant chemotherapy for HER2—positive breast cancer. Participants:Overall, 27 patients with HER2—positive breast cancer who had completed neoadjuvant chemotherapy and undergone surgery between January 2014 and January 2020 were included in the study. We performed a retrospective analysis of the relationship between HER2 gene amplification and the therapeutic effect of pertuzumab in this group. For the anti—HER2 treatment, only trastuzumab was administered to all patients until December 2018, and then a combination of trastuzumab and pertuzumab was administered to 4 patients from January 2019. Results:The case distribution based on histological therapeutic effect was:4 patients with Grade 1, 12 patients with Grade 2, and 11 patients with Grade 3. Patients with immunohistochemistry scores of 3+ and high signal ratios of HER2/CEP17 in FISH testing tended to have better therapeutic outcomes than other patients. Discussion:Outcomes similar to those observed in this study were reported in other cases where pertuzumab was used for anti—HER2 treatment. We expected that the therapeutic effects of pertuzumab would be better in patients with high HER2 expression. However, further research is required to understand the effects of pertuzumab in patients with cT1c that were not included in the Neo Sphere trial. The therapeutic effects of adding pertuzumab to the treatment in patients with cT1c and lymph node—positive breast cancer were indicated by comparison with our cases.
要旨
目的:HER2陽性乳癌に対する術前化学療法におけるpertuzumab併用の適応症例について考察する。対象:2014年1月～2020年1月までに術前化学療法を施行したHER2陽性乳癌27例を対象に,HER2遺伝子増幅の程度と治療効果の関連を後方視的に検討した。抗HER2療法は2018年12月までの症例ではtrastuzumabのみを使用し,2019年1月以降の症例のうち4例でpertuzumabを併用した。結果:組織学的治療効果はGrade 1が4例,Grade 2が12例,Grade 3が11例であった。FISH法のHER2/CEP17総シグナル比が高い症例やscore 3+の症例で治療効果が高い傾向があった。考察:pertuzumab併用例でも今回の結果と同様の傾向が報告されており,HER2高発現症例へのpertuzumab上乗せ効果が高いと考える。NeoSphere試験で対象となっていないcT1c症例への上乗せについては検討の余地があり,自験例の比較からcT1cリンパ節転移陽性の症例への上乗せ効果が示唆された。
目次
Objective:We examined the therapeutic effect of adding of pertuzumab in combination with trastuzumab as neoadjuvant chemotherapy for HER2—positive breast cancer. Participants:Overall, 27 patients with HER2—positive breast cancer who had completed neoadjuvant chemotherapy and undergone surgery between January 2014 and January 2020 were included in the study. We performed a retrospective analysis of the relationship between HER2 gene amplification and the therapeutic effect of pertuzumab in this group. For the anti—HER2 treatment, only trastuzumab was administered to all patients until December 2018, and then a combination of trastuzumab and pertuzumab was administered to 4 patients from January 2019. Results:The case distribution based on histological therapeutic effect was:4 patients with Grade 1, 12 patients with Grade 2, and 11 patients with Grade 3. Patients with immunohistochemistry scores of 3+ and high signal ratios of HER2/CEP17 in FISH testing tended to have better therapeutic outcomes than other patients. Discussion:Outcomes similar to those observed in this study were reported in other cases where pertuzumab was used for anti—HER2 treatment. We expected that the therapeutic effects of pertuzumab would be better in patients with high HER2 expression. However, further research is required to understand the effects of pertuzumab in patients with cT1c that were not included in the Neo Sphere trial. The therapeutic effects of adding pertuzumab to the treatment in patients with cT1c and lymph node—positive breast cancer were indicated by comparison with our cases.
要旨
目的:HER2陽性乳癌に対する術前化学療法におけるpertuzumab併用の適応症例について考察する。対象:2014年1月～2020年1月までに術前化学療法を施行したHER2陽性乳癌27例を対象に,HER2遺伝子増幅の程度と治療効果の関連を後方視的に検討した。抗HER2療法は2018年12月までの症例ではtrastuzumabのみを使用し,2019年1月以降の症例のうち4例でpertuzumabを併用した。結果:組織学的治療効果はGrade 1が4例,Grade 2が12例,Grade 3が11例であった。FISH法のHER2/CEP17総シグナル比が高い症例やscore 3+の症例で治療効果が高い傾向があった。考察:pertuzumab併用例でも今回の結果と同様の傾向が報告されており,HER2高発現症例へのpertuzumab上乗せ効果が高いと考える。NeoSphere試験で対象となっていないcT1c症例への上乗せについては検討の余地があり,自験例の比較からcT1cリンパ節転移陽性の症例への上乗せ効果が示唆された。