Preoperative treatment for locally advanced HER-2-positive breast cancer

doi:10.3877/cma.j.issn.1674-0807.2025.03.001

Abstract

Abstract:

HER-2-positive locally advanced breast cancer (LABC) remains challenging to treat due to its aggressive biology and propensity for drug resistance. Currently, dual-targeted therapy (trastuzumab plus pertuzumab) combined with chemotherapy has increased pCR rates to 40%-60%; however, the risk of recurrence persists. Recently, significant advances have been made in preoperative treatment strategies, antibody-drug conjugates with high drug-to-antibody ratios and pronounced bystander effects, such as trastuzumab deruxtecan, have markedly enhanced therapeutic efficacy; tyrosine kinase inhibitors and bispecific antibodies have improved overall anti-tumor activity through multi-pathway synergistic inhibition. Additionally, chemotherapy de-escalation approaches, such as chemo-free regimens selected by imaging and metabolic assessment, the incorporation of immunotherapy, and fully oral regimens for triple-positive breast cancer, have significantly broadened personalized treatment options. Future efforts should focus on the identification of multi-omics biomarkers, optimization of targeted therapies and comprehensive management strategies to further overcome resistance, balance efficacy and quality of life, and ultimately achieve breakthroughs in precision oncology.

Key words: Breast neoplasms, Neoadjuvant therapy, Treatment outcome, Molecular targeted therapy, Chemotherapy

Mingxia Jiang, Qiao Li, Binghe Xu. Preoperative treatment for locally advanced HER-2-positive breast cancer[J]. Chinese Journal of Breast Disease(Electronic Edition), 2025, 19(03): 129-138.

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