안녕하세요. 유방암에서의 수술 전 보조요법에 대한 토픽 발표를 정리하겠습니다.
수술 전 보조요법의 장점은 다음과 같습니다.(Benefits)
- To make inoperable tumors operable
- To achieve breast conservation surgery
- To reduce the need for complete ALNB
- To increase overall survival rate
- Treatment response provides important prognostic information at an individual patient level, particulary in patients with TNBC or HER-2 positive bresat cancer
수술 전 보조요법의 적응증은 다음과 같습니다. (Indication)
1) Patients with inoperable breast cancer
- Inflammatory breast cancer
- Bulky or matted N2 axillary nodes
- cN3 nodal disease
- T4 tumors
2) Patients with operable breast cancer
- preferred for HER2-positive disease and TNBC, if ≥cT2 or ≥cN1
- Large primary tumor relative to breast size in a patient who desires breast conservation
- cN+ disease likely to become cN0 with preoperative systemic therapy
3) Patients in whom definitive surgery may be delayed
Pathologic complete response(pCR)
- Defined as no invasive and no in situ residuals in breast and nodes
- Is associated with an extremely favorable Event-free and overall survival
- ypT0 ypN0: absence of invasive cancer and in-situ cancer in breast and axillar nodes
- ypT0/is ypN0: absence of invasive cancer in breast and axillar nodes
- ypT0/is : absence of invasive cancer in breast
HER2-negative preferred regimens
- Dose-dense AC(doxorubicin/cyclophosphamide) followed by paclitaxel every 2 weeks
- Dose-dense AC(doxorubicin/cyclophosphamide) followed by weekly paclitaxel
- TC(docetaxel and cyclophosphamide)
- Olaparib, if germline BRCA 1/2 mutations
- High-risk triple-negative breast cancer(TNBC):
preoperative pembrolizumab + carboplatin + paclitaxel,
followed by preoperative pembrolizumab + cyclophosphamide + doxorubicin or epirubicin,
followed by adjuvant pembrolizumab
- TNBC and residual disease after preoperative therapy: Capecitabine
HER2-positive preferred regimens
- Paclitaxel + trastuzumab
- TCH(docetaxel/carboplatin/trastuzumab)
- TCHP(docetaxel/carboplatin/trastuzumab/pertuzumab)
- If no residual disease after preoperative therapy or no preoperative therapy: complete up to one year of HER2-targeted therapy with trastuzumab ± pertuzumab
- If residual disease after preoperative therapy: ado-trastuzumab emtansine alone.
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