Implications of Neoadjuvant Therapy in Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer

Mené sur 444 patientes atteintes d'un cancer du sein HER2+, cet essai de phase III compare l'efficacité, du point de vue de la survie sans événement, de la survie globale, de la survie sans maladie invasive à 3 ans, et la toxicité d'un traitement néoadjuvant combinant trastuzumab emtansine et pertuzumab, et d'un traitement néoadjuvant à base de docétaxel, carboplatine, trastuzumab et pertuzumab (durée médiane de suivi : 37 mois)

Résumé en anglais

Breast cancer outcomes have markedly improved in great part because of advances in therapy. These improved outcomes, however, have been accompanied by greater financial costs, toxicities, and overtreatment of a substantial number of patients. We must now focus on studies that leverage our accumulated knowledge and use a more individualized approach for the locoregional1 and systemic management of this disease.2-4 De-escalation trials can be harder to perform as a result of the complexities of noninferiority designs, difficulty in funding them, and human nature. Behavioral economists find that people experience negative feelings about losses more strongly than positive feelings about gains of similar size.5 This makes it harder to conduct trials that are designed to treat breast cancer precisely rather than comprehensively, including studies that aim to de-escalate standard therapy.