How is HER2/neu-positive locally advanced breast cancer treated?

Answer

In patients with HER2/neu-positive disease, concurrent trastuzumab with chemotherapy improves the pCR rate. Regimens are listed below.

AC-paclitaxel plus trastuzumab

Doxorubicin 60 mg/m ² IV plus cyclophosphamide 600 mg/ ² IV on day 1 every 3 wk for 4 cycles, followed by
Paclitaxel 80 mg/m ² IV weekly for 12 weeks or paclitaxel 175mg/m2 every 3 wk for 4 cycles with:
Trastuzumab 4 mg/kg IV with first dose of paclitaxel, followed by
Trastuzumab 2 mg/kg IV weekly to complete 1-y total duration of trastuzumab therapy
As an alternative, trastuzumab 6 mg/kg IV every 3 wk following the completion of paclitaxel, to complete 1-y total duration of trastuzumab therapy ^[14]

Dose-dense AC–paclitaxel plus trastuzumab

Doxorubicin 60 mg/m ² IV plus cyclophosphamide 600 mg/m ² IV on day 1 every 2 wk for 4 cycles, followed by
Paclitaxel 175 mg/m ² IV every 2 wk for four cycles, with
Trastuzumab 4 mg/kg for the first dose and then 2 mg/kg weekly for 1-y total duration
As an alternative, trastuzumab 6 mg/kg every 3 wk following the completion of paclitaxel, and given to complete 1-y total duration of trastuzumab therapy ^[15]

AC-docetaxel plus trastuzumab

Doxorubicin 60 mg/m ² IV plus cyclophosphamide 600 mg/m ² IV on day 1 every 3 wk for four cycles, followed by
Docetaxel 100 mg/m ² every 3 wk for four cycles, with
Trastuzumab 4 mg/kg IV during week 1 and then 2 mg/kg IV weekly for 11 wk; followed by trastuzumab 6 mg/kg every 3 wk to complete 1 y of trastuzumab ^[15]

AC-paclitaxel plus trastuzumab and pertuzumab

Doxorubicin 60 mg/m ² IV plus cyclophosphamide 600 mg/m ² IV on day 1 every 3 wk for four cycles, with
Followed by paclitaxel 80 mg/m ² IV days 1, 8, 15 every 3 wk for four cycles with
Pertuzumab 840 mg IV followed pertuzumab 420mg IV and trastuzumab 8 mg/kg IV for the first dose and then 6 mg/kg IV every 3 wk for four cycles
Then, trastuzumab 6 mg/kg IV every 3 wk to complete 1-yr trastuzumab therapy

AC-docetaxel plus trastuzumab and pertuzumab

Doxorubicin 60 mg/m ² IV plus cyclophosphamide 600 mg/m ² IV on day 1 every 3 wk for four cycles
Followed by docetaxel 75-100 mg/ ² every 3 wk for four cycles, with
Pertuzumab 840 mg IV followed pertuzumab 420 mg IV and trastuzumab 8 mg/kg IV followed by trastuzumab 6 mg/kg every 3 wk for four cycles
Trastuzumab 6 mg/kg every 3 wk to complete 1 y of trastuzumab therapy

TCH plus pertuzumab

Docetaxel 75 mg/m ² plus carboplatin AUC 6 IV every 3 wk for 6 cycles with
Pertuzumab 840 mg IV followed pertuzumab 420mg IV and trastuzumab 8 mg/kg IV followed by trastuzumab 6 mg/kg IV every 3 wk for six cycles, followed by
Trastuzumab 6 mg/kg IV every 3 wk to complete 1-y total duration of trastuzumab therapy
As an alternative, trastuzumab 8 mg/kg followed by trastuzumab 6 mg/kg every 3 wk to complete 1-y total duration of trastuzumab therapy

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