Review Article
Predictive Factors of Response in HER2-Positive Breast Cancer Treated by Neoadjuvant Therapy
Table 2
Randomized trials with neoadjuvant lapatinib versus trastuzumab or lapatinib versus trastuzumab versus lapatinib plus trastuzumab.
| | Study (ref.) | No. of pts | Clinical stage | Neoadjuvant chemotherapy | Neoadjuvant anti-HER2 therapy | pCR rate (%) | cCR (%) | Breast-conserving surgery rate (%) |
| NeoALTTO [12],
phase III | 455 | T > 2 cm, any N | Weekly P (12 w) | (i) Trastuzumab 4 → 2 mg/kg/w
(ii) Lapatinib 1500 mg/d
(iii) Lapatinib 1000 mg/d + trastuzumab 2 mg/kg/w | 28%
20%
47% | NR | 39%
43%
41% | GeparQuinto [13],
phase III | 615 | cT3/4a–d or HR− or cT2cN+ HR+ or cT1pNSLN+ HR+ | EC (4 c) → Doc (4 c) | (i) Trastuzumab 8 → 6 mg/kg/3 w
(ii) Lapatinib 1250 mg/d (adjustment to 1000 mg/d) | 44%
30% | 33%
28.5% | 64%
59% | CHER-LOB [14],
phase II | 121 | II–IIIA | Weekly P (12 w) → FEC (4 c) | (i) Trastuzumab 4 → 2 mg/kg/w
(ii) Lapatinib 1500 mg/d
(iii) Lapatinib 1000 mg/d + trastuzumab 2 mg/kg/w | 25%
26%
47% | NR | 67%
58%
69% | NSABP B-41 [15],
phase III | 464 | T > 2 cm, any N | AC (4 c) → P (D1, 8, 15, 28; 4 c) | (i) Trastuzumab 4 → 2 mg/kg/w
(ii) Lapatinib: 1250 mg/d
(iii) Lapatinib 750 mg/d + trastuzumab 2 mg/kg/w | 49%
47%
60% | 82%
70%
77% | 54%
46%
50% | Holmes et al. [16],
phase II | 100 | II-III | FEC75 (4 c) → weekly P (12 w) | (i) Trastuzumab 4 → 2 mg/kg/w
(ii) Lapatinib 1250 mg/d
(iii) Lapatinib 750 mg/d + trastuzumab 2 mg/kg | 54%
45%
74% | NR | NR | GEICAM 2006-14 [17],
phase II | 99 | T > 2 cm or N+ any T | EC (4 c) → Doc (4 c) | (i) Trastuzumab: 8 → 6 mg/kg/3 w
(ii) Lapatinib: 1250 mg/d | 48%
24% | NR | 58%
58% |
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pCR: pathological complete response; cCR: clinical complete response; NR: not reported; HR: hormonal receptors; EC: Epirubicin + Cyclophosphamide; Doc: Docetaxel; FEC: 5fluoro-uracile-epirubicine-cyclophosphamide; AC: adriamycin-cyclophosphamide.
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