Professor Fan Zhimin interview: T-DM1 treatment of HER2 positive non-pCR breast cancer face

T-DM1, as the first ADC drug in the field of breast cancer treatment, has been approved in China for intensive assisted treatment after new assisted treatment of HER2-positive early breast cancer, which does not reach full remission of pathologySo what disruption will the drug bring to her2-positive breast cancer treatment and what advantages will it have in clinical use?the role and significance of new complementary treatment in breast cancer treatment
new complementary treatment includes new assisted endocrine therapy, chemotherapy, targeted treatment and so onFor patients, the purpose of the new auxiliary treatment is mainly three aspects, one, make the non-surgical breast cancer into surgical breast cancer, to achieve the reduction of tumor; In the analysis of tumor resistance in the new complementary treatment, first-line treatment drugs including yew alcohol, fentanyl and target ingestcanl can be tried to observe whether the tumor shrinks or progresses, and if there is progress, the drug needs to be replaced; After the new auxiliary treatment, the tumor has only two outcomes, one is the pCR (pathological total remission) including the breast and armpits, and the other is the breast or armpit, respectively, there is residual or simultaneous residual lesions of non-pCR (non-pathological complete remission)Therefore, the new complementary treatment can enable doctors to be informed of the sensitivity of first-line treatment drugs at the end of the new auxiliary treatment and after surgery, respectively, according to the tumor withdrawal and whether pCR is reachedbecause of the increase in new complementary treatments, treatment regimens have gradually shifted from the past based anatomical to molecular biology or the biological characteristics of tumors, e.gpatients who are HER2-positive, tend to use two-target combination chemotherapy treatment regimensProfit-seeking avoids harm, so that the benefit of the patient maximizesHER2-positive early breast cancer treatment decision point: pCR orreview the her2-positive early breast cancer treatment history, we can see that the earliest according to NOAH research, in the NEW assisted treatment of HER2-positive breast cancer filled with qutobeu monoantigen, changed the prognosis of patients, laid the cornerstone status of quto bead monoantigen in HER2-positive breast cancer treatmentThis was followed by an 11-year HERA study followed, which compared the treatment of qutobeu monoantigen for 1 and 2 years in the new or auxiliary treatment, the course of 1 year was optimal, and the patient's heart toxicity increased despite the same efficacy, so the study determined the optimal course of treatment for qutozumabAccording to the N9831 and NSABPB31 clinical trials, patients with a better prognosis were given a better prognosis after 8.4 years of follow-upRecently, the results of the 10-year BCIRG006 study have been revealed, and ac-TH and TCH programs are better than AC-TThe above studies establish the status of joint targeting of assisted treatment after HER2-positive breast cancer, either AC-TH or TCH, based on chemotherapyfollowed closely, there were two joint directions, one, according to the APHINITY study, in the new assisted and auxiliary treatment of HER2-positive breast cancer patients appeared in the program of quto-pato's tote-two-target combination of yew alcohol, has become the current domestic and foreign guidelines of the first-line recommendation;recently, the most popular in the field of breast cancer treatment is the KATHERINE studyIn the past, for HER2-positive patients, after the new auxiliary treatment, if non-pCR, only after the postoperative assisted therapy can be given 1 year of qutobeu monoantigenAfter the aphinity study, the right double target for postoperative assisted therapy in patients with non-pCR is also an optionHowever, the KATHERINE study, which compared T-DM1 with qutobeumonoresistance, confirmed that T-DM1 reduced the risk of distant metastasis and death by about 50%, and the results were the best results for non-pCR patients with new complementary treatments in the field of antiHER2 therapyIt is worth noting that T-DM1 belongs to the antibody drug conjugate (ADC), that is, by antibody, powerful toxin small molecules through a stable connectivity of the body, in which the meldonium anti-cancer effect is 150 to 300 times stronger than the anti-cyclotropic drugsAccording to THE KATHERINE study, whether the new assisted treatment plan of HER2 positive is qutobeu mono-anti-combination chemotherapy, or quto-bead mono-resistant pluspato-bee mono-combined chemotherapy, as long as postoperatively confirmed as non-pCR patients, can use T-DM1, which has become the standard program recommended by domestic and foreign guidelinesmake good medicine sable, make good medicine availableAccording to KATHERINE research, the main toxic side effect of T-DM1 is platelet decline, of course, the vast majority of the decline is controlledTherefore, when using T-DM1, care should be paid to close monitoringAs for how to get the most out of breast cancer patients? First, the accuracy of pathological assessment should be improved, accurate pathological diagnosis and biomarker testing are the basis of new complementary treatment; pCR, three-negative breast cancer plus Capetabin, and HER2-positive patients choose T-DM1; T-DM1 has been listed in China on April 8 this year, and now domestic and foreign guidelines also recommend T-DM1 as a first-line treatment for non-pCR patients after HER2 positive new complementary treatmentThe drug is not yet included in China's health insurance, but it has been heard that the foundation has announced a charitable drug, as well as "rest assured" insurance program to benefit patients;author: Fan Zhimin Source:, Oncology Information