Towards response-adapted neoadjuvant breast cancer treatment
Mené aux Pays-Bas sur 232 patientes atteintes d'un cancer du sein de stade précoce HER2+ (durée médiane de suivi : 40,1 mois), cet essai de phase II évalue l'efficacité, du point de vue de la survie sans événement à 3 ans, et la toxicité d'une chimiothérapie néoadjuvante administrée jusqu'à réponse radiologique complète mesurée par IRM
The therapeutic landscape of early-stage HER2-positive breast cancer has been transformed over the past two decades.1 The introduction of HER2-directed therapy, including the antibody trastuzumab, has fundamentally altered the natural history of this disease, converting an aggressive breast cancer subtype associated with poor outcomes into one with high rates of pathological complete response and excellent long-term survival.1,2 These gains were initially achieved using intensive multi-agent regimens incorporating HER2-directed therapies with anthracyclines, taxanes, and platinum chemotherapy in both the adjuvant and neoadjuvant settings. However, with greater understanding of how tumour heterogeneity affects treatment sensitivity, uniform application of intensive regimens might result in overtreatment for a substantial subset of patients who could achieve excellent clinical outcomes with a less burdensome approach. In response, contemporary research has focused on tailoring systemic therapy while preserving treatment efficacy, including a reduction in chemotherapy intensity or duration and, in the preoperative setting, response-adapted approaches informed by early indicators of treatment sensitivity.
The Lancet Oncology , commentaire, 2026