title: [Current situation and issues regarding preoperative chemotherapy for HER2-positive breast cancer].
abstract: OBJECTIVE
  The clinical significance of preoperative chemotherapy, including trastuzumab for HER2-positive breast cancer, was examined based on hormone receptors(HR)to clarify future issues.
  
  
  METHODS
  104 HER2-positive breast cancer patients who completed preoperative chemotherapy and underwent surgery from May 2005 to August 2010. All patients received sequential treatment with taxane±trastuzumab for FEC(5-FU+epirubicin+cyclophosphamide)therapy, and from 2008 they received trastuzumab postoperatively for one year.
  
  
  RESULTS
  Concerning the histological effects, the rate of comprehensive pCR(CpCR)in the 104 patients(31 HR-negative administered trastuzumab, 15 HR-negative not administered trastuzumab, 28 HR-positive administered trastuzumab, 30 HR-positive not administered trastuzumab)was 65%, 47%, 21% and 23% for each group, respectively CpCR was a significant factor(p<0. 05)in prolonged distant disease-free survival(DDFS)in the HR-negative group. Distant metastasis occurred in 14 patients, namely, brain metastasis in 7 patients(4 HR-negative administered trastuzumab, 1 HR-negative not administered trastuzumab, 2 HR-positive administered trastuzumab). The therapeutic efficacy was pINV in 5 of these 7 patients(3HR-negative administered trastuzumab, 1 HR-negative not administered trastuzumab, 1 HR-positive administered trastuzumab), and 4 of those 5 patients received trastuzumab postoperatively.
  
  
  CONCLUSIONS
  The responsiveness to preoperative chemotherapy including trastuzumab for HER2-positive breast cancer differs between HR-positive and HR-negative. pINV patients seem to be at a high risk for brain metastasis regardless of HR, and it may be difficult to suppress its occurrence only with trastuzumab adjuvant therapy.
authors.affiliation: Dept. of Surgery, National Hospital Organization, Osaka National Hospital, Japan.
authors.forename: Makiko
authors.initials: M
authors.lastname: Mizutani
authors.forename: Norikazu
authors.initials: N
authors.lastname: Masuda
authors.forename: Hajime
authors.initials: H
authors.lastname: Abe
authors.forename: Jun
authors.initials: J
authors.lastname: Yamamura
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yasojima
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Kodama
authors.forename: Tomoko
authors.initials: T
authors.lastname: Umeda
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Kurumi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Mano
authors.forename: Toru
authors.initials: T
authors.lastname: Tani
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D012008:Recurrence; D012189:Retrospective Studies; D000068878:Trastuzumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human