The preferred strategy of new auxiliary treatment of breast cancer is discussed and the preferred strategy is discussed.

To explore the new adjuvant therapy for HER2 positive and triple negative breast cancer.on June 28, 2020, t-talk show was launched.Professor Ye Songqing from Fujian Provincial Hospital, Hao Chunfang from Cancer Hospital of Tianjin Medical University, Professor Qi Xiaowei from Southwest Hospital of Army Military Medical University, Professor Zhang Liulu of Guangdong Provincial People's Hospital and Professor Hu Hong of Shenzhen People's Hospital discussed the new adjuvant therapy for HER2 positive and triple negative breast cancer (TNBC) It can help clinicians to develop diagnosis and treatment ideas and provide detailed basis for clinical decision-making.Prof. Qi Xiaowei: hot issues of neoadjuvant therapy for HER2 positive breast cancer. The tcbhp (docetaxel + carboplatin + trastuzumab + patuzumab) regimen and THP (docetaxel + trastuzumab + patuzumab) regimen are recommended as class I neoadjuvant therapy for HER2 positive breast cancer in 2020 Chinese society of Clinical Oncology (CSCO) guidelines for clinical diagnosis and treatment of breast cancer.however, tcbhp regimen has a higher rate of pathological complete remission (PCR), has both short-term and long-term effects, and has short-term and good compliance, so it can be used as a clinical priority.after two cycles of neoadjuvant therapy, if it is assessed as disease progression (PD), it can be considered to change the protocol; if it is assessed as stable disease (SD), it should be re evaluated after two cycles of the original regimen.1 in the era of dual target neoadjuvant therapy, the status of anthracyclines has declined, and it is necessary to screen the benefit population. The study of train-2 showed that in the neoadjuvant treatment of HER2 positive breast cancer, there was no difference in the PCR rate between double target combination of anthracyclines and non anthracyclines (67% vs 68%, P = 0.95), and 3-year event free survival (EFS) was observed There was no significant difference in the overall survival (OS) rate and 3-year survival rate, but anthracycline was more toxic.Figure 1. Three year OS results of train-2 study showed that the status of anthracyclines decreased in the dual target era. Anthracyclines containing regimens were recommended as class II neoadjuvant therapy in 2020 CSCO guidelines for clinical diagnosis and treatment of breast cancer.however, Professor Ye Songqing believes that the results of train-2 research are more likely to come up with a preferred scheme rather than the anthracycline removal scheme.Professor Hao Chunfang pointed out that anthracyclines still have application value in neoadjuvant therapy for specific population such as patients with low heart risk.2 in the absence of anthracycline, the current evidence shows that tcbhp regimen is better than THP regimen. The Kristine study compared the efficacy of tcbhp regimen and t-dm1 + patuzumab neoadjuvant therapy for HER2 positive breast cancer. The results showed that the PCR rate of tcbhp group was 56%, the overall 3-year disease-free survival (IDFs) was 92%, and the 3-year IDFs rate of PCR patients was 97.5%.Fig. 2. Kristine results the Swedish predix HER2 phase II study compared the efficacy of THP regimen and t-dm1 regimen in neoadjuvant therapy for HER2 positive breast cancer. The results showed that the PCR rate of 6 cycles of THP regimen neoadjuvant therapy was 47%, and there was no survival data.Table 1. Preliminary analysis results of predix HER2 phase II study showed that tcbhp regimen had higher PCR rate than THP regimen and showed long-term benefits. Therefore, Professor Qi Xiaowei believed that tcbhp regimen should be preferred. For patients who could not tolerate platinum therapy, or had hematologic diseases and other contraindications, THP regimen could be selected.Professor Hu Hong said that in clinical studies, the THP regimen is often followed by anthracycline drugs and lacks long-term survival data, so it is not preferred at this stage.Professor Hao Chunfang and Professor Ye Songqing also pointed out that THP is not a complete neoadjuvant therapy, and its value needs to be proved by more studies.3 in the double target era, some highly selective people are expected to be exempted from traditional chemotherapy. The HER2 heterogeneity study of Harvard University Dana Faber cancer center confirmed that in the population without HER2 heterogeneity, the PCR rate of 6 cycles of t-dm1 + patuzumab neoadjuvant therapy can reach 55% The study also explored the possibility of neoadjuvant chemotherapy for HER2 positive breast cancer. The results showed that the PCR rate of responders in PET evaluation reached 37.9% after two cycles of treatment.these two studies suggest that neoadjuvant chemotherapy is a recommended option in some highly selective populations. Figure 3. Results of phergain study 4: early assessment of SD / PD after double target neoadjuvant, how to deal with it? In the phergain study, after 6 cycles of treatment, the PCR rate of the responders evaluated by PET was 65.6%, while that of the responders evaluated by PET was only 10%. It is suggested that early evaluation of curative effect by appropriate means can help doctors predict the PCR rate and timely adjust the treatment strategies of some patients. Fig. 4. Treatment strategies for patients with poor initial dual target therapy in the neoadjuvant stage. With regard to the efficacy evaluation and scheme adjustment of neoadjuvant therapy, Prof. Hu Hong and Professor Zhang Liulu believe that after two cycles of treatment, the patients with SD who are evaluated as SD will be re evaluated after two cycles of treatment, while those who are evaluated as PD will be considered to change their plans. Professor Qi Xiaowei said that for patients who were assessed as SD in two cycles, they might also consider adjusting the treatment plan. Professor Zhang Liulu: To explore the optimal neoadjuvant regimen for triple negative breast cancer. when using platinum neoadjuvant chemotherapy, platinum combined with docetaxel is usually used. for patients who did not receive PCR (non PCR) after neoadjuvant therapy of TNBC, the standardized treatment was carried out according to the clinical guidelines. one of the development directions in the future is to choose a more appropriate treatment scheme through more fine stratification of patients. 1 non dense dose anthracycline sequential paclitaxel regimen is the preferred neoadjuvant chemotherapy for TNBC. Based on the concept of combining neoadjuvant and adjuvant therapy, the national comprehensive cancer network (NCCN) of the United States has selected paclitaxel and anthracycline intensive chemotherapy as one of the best neoadjuvant or adjuvant chemotherapy options. the ago-1 trial and the prepare study confirmed that intensive chemotherapy can improve the PCR rate. however, in the gepar-duo study, the PCR rate of intensive chemotherapy regimen was lower (7.0% vs 14.3%), which may be related to shorter chemotherapy time, lower dose intensity and different chemotherapeutic drugs between the two groups. Table 2. Comparison of efficacy between intensive chemotherapy and traditional chemotherapy shows that the optimal combination and dose of intensive chemotherapy still need to be explored, and the efficacy and adverse reactions should be balanced. therefore, the 2017 St. Gallen expert vote showed that 74.5% of the experts believed that the non dense dose anthracycline sequential paclitaxel regimen was still the preferred neoadjuvant chemotherapy for TNBC (regardless of BRCA status). The neostop study found that docetaxel plus carboplatin (TCB) regimen and paclitaxel + carboplatin sequential anthracycline + cyclophosphamide (pcb-ac) regimen had similar PCR rates, and the residual tumor burden (RCB) 0 / 1 rate was 67%, and TCB regimen 3-4 had similar PCR rates The incidence of grade I adverse events was significantly lower (21% vs 73%, P & lt; 0.0001). in the 2020 edition of NCCN breast cancer guidelines, docetaxel combined with carboplatin is recommended when neoadjuvant therapy and rapid local control are desired. Fig. 5. According to the results of neostop study, Professor Qi Xiaowei believes that platinum based on anthracyclines and taxanes can rapidly shrink tumor, but it will not be widely recognized in clinic due to lack of survival data. Professor Hu Hong said that platinum and taxanes may be added to the follow-up treatment if anthracyclines are not effective in the early stage. for the follow-up treatment plan of non PCR patients after TNBC neoadjuvant treatment, field experts also conducted in-depth discussion. Professor Zhang Liulu stressed that the significance of neoadjuvant therapy is not only to improve the PCR rate by exploring the optimal scheme, but also to select non PCR population for postoperative intensive treatment, so as to improve the prognosis. at the end of the meeting, Professor Hao Chunfang, chairman of the conference, summarized that through online academic exchanges, clinical ideas could be better understood and better treatment plans could be provided for patients. in addition, there are still many problems to be solved in the field of neoadjuvant therapy of breast cancer, and we look forward to carrying out more research and further exploration in China. MAT-CN-2011326-1.0-07/2020