1. Understanding HER2-Positive Breast Cancer:
HER2-positive breast cancer is an aggressive subtype of breast cancer, yet advances in targeted therapies have drastically improved outcomes. Modern approaches emphasize the use of Dual Targeted trastuzumab and pertuzumab for optimal results.
2. Why Neoadjuvant Therapy First?
For early-stage HER2-positive breast cancer (tumor sizes T1 or T2, even with one node positive), upfront surgery is not ideal. Neoadjuvant chemotherapy combined with targeted therapy offers better prognostic and therapeutic outcomes.
3. Key Advantages of Neoadjuvant Therapy:
- Achieving Complete Response (CR):
- A complete response often eradicates the primary cancer, reducing the need for extensive surgery.
Cost Efficiency:
Patients undergoing upfront surgery frequently face escalated treatment costs for post-operative targeted therapy. Neoadjuvant therapy allows prioritization of resources especially deescalating targeted drugs in situations when response to Neo Adjuvant treatment has been good
Prognostic Insights:
CR after neoadjuvant therapy serves as a strong indicator of favorable long-term outcomes. This invaluable prognostic opportunity is missed with upfront surgery.
4. Addressing Patient Concerns:
Patients and families often face confusion and anxiety regarding affordability and recurrence risks post-surgery.
Starting with neoadjuvant therapy alleviates these concerns by achieving visible results early in treatment.
5. Streamlined Decision-Making:
In cases of HER2-positive breast cancer, achieving CR resolves major uncertainties.
Even if a patient cannot afford prolonged targeted therapy, a good response to initial neoadjuvant cycles addresses the primary challenge effectively.
6. A Clear Recommendation for Colleagues:
For early or curable HER2-positive breast cancer, always consider neoadjuvant therapy first.
This approach offers patients the best chance of a complete cure while allowing for cost-effective and informed decision-making.
7. The Bottom Line:
Avoid upfront surgery for HER2-positive breast cancer in early-stage cases (except in tumors <1 cm).
Opting for neoadjuvant therapy first not only enhances the chances of achieving CR but also improves overall patient outcomes and satisfaction.
Dr. Mandeep Singh Malhotra emphasizes that integrating neoadjuvant therapy into treatment protocols for HER2-positive breast cancer ensures better prognostic clarity, affordability, and, most importantly, hope for patients.
