MDT discussion and rethink of comprehensive treatment for 2 cases of HER-2 positive breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Yuting ¹ , Alexander Tobias Teichmann ² , WU Bin ¹ , HE Lijia ³ , XIAO Xiuli ⁴ , CHEN Xiaomei ⁵ , ZHAO Dongmei ⁶ ,  ZUO Huaiquan ¹

1. Department of Breast Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Sichuan Gynecology and Breast Disease Treatment Center, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
3. Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
4. Department of Pathology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
5. Department of Ultrasound, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
6. Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

ZUO Huaiquan, Email: 13982772996@163.com

Keywords：

breast cancer; comprehensive treatment; multidisciplinary team; precision medicine

DOI：

10.7507/1007-9424.202009004

Video：

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Objective To explore the value of multidisciplinary team (MDT) discussion in the comprehensive treatment of HER-2 positive breast cancer.Method The clinical data of 2 patients with HER-2 positive breast cancer admitted to the Affiliated Hospital of Southwest Medical University after MDT discussions were analyzed retrospectively.Results Case 1 was a 32-year-old woman diagnosed with left breast non-special type invasive carcinoma at admission, cT2N1M0, stage ⅡB, WHO grade 2, ER (–), PR (–), HER-2 (+++), Ki-67 (+, 20%). After MDT discussion, the patient was treated with neoadjuvant chemotherapy for 6 cycles, and the efficacy evaluation was partial response, received left breast conserving surgery and axillary lymph node dissection (ALND), postoperative staging ypT1aN1ycM0, stage ⅡA, Miller-Payne grade 4, the patient was satisfied with the shape of breast, received radiotherapy and anti-HER-2 therapy after surgery. At present, there was no recurrence and metastasis during anti-HER-2 therapy. Case 2 was diagnosed with right breast non-special type invasive carcinoma at admission, cT3N0M0, stage ⅡB, WHO grade 3, ER (–), PR (–), HER-2 (+++), Ki-67 (+, 40%), local advanced breast cancer. After MDT discussion, the patient was treated with neoadjuvant chemotherapy for 2 cycles, and the efficacy evaluation was progressive disease. After the replacement of two neoadjuvant chemotherapy regimen, the efficacy evaluation was still progressive disease. Finally after MDT discussion, the patient received right breast mastectomy and ALND, postoperative staging ypT4bN1ycM0, stage ⅢB, Miller-Payne grade 1, received radiotherapy, adjuvant treatment with pyrotinib and capecitabine after surgery. The patient was followed up for 3 months by telephone, the patient did not follow the doctor’ instructions, no recurrence and metastasis was found in the review.Conclusion Under the precision medical system, comprehensive treatment of breast cancer based on the MDT model could target patients’ disease characteristics, physical conditions, previous diagnosis and treatment, family situation, and other individual factors, formulate the best personal treatment plan for patients, and bring greater benefits to patients.

Citation： WU Yuting, Alexander Tobias Teichmann, WU Bin, HE Lijia, XIAO Xiuli, CHEN Xiaomei, ZHAO Dongmei, ZUO Huaiquan. MDT discussion and rethink of comprehensive treatment for 2 cases of HER-2 positive breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(4): 500-507. doi: 10.7507/1007-9424.202009004 Copy

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2.	Gianni L, Eiermann W, Semiglazov V, et al. Neoadjuvant and adjuvant trastuzumab in patients with HER2-positive locally advanced breast cancer (NOAH): follow-up of a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet Oncol, 2014, 15(6): 640-647.
3.	Untch M, Thomssen C, Bauerfeind I, et al. Primary therapy of early breast cancer: Evidence, controversies, consensus: spectrum of opinion of German specialists on the 16th St. Gallen International Breast Cancer Conference (Vienna 2019). Geburtshilfe Frauenheilkd, 2019, 79(6): 591-604.
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5.	Gianni L, Pienkowski T, Im YH, et al. 5-year analysis of neoadjuvant pertuzumab and trastuzumab in patients with locally advanced, inflammatory, or early-stage HER2-positive breast cancer (NeoSphere): a multicentre, open-label, phase 2 randomised trial. Lancet Oncol, 2016, 17(6): 791-800.
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9.	Gianni L, Eiermann W, Semiglazov V, et al. Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet, 2010, 375(9712): 377-384.
10.	Hurvitz SA, Martin M, Symmans WF, et al. Neoadjuvant trastuzumab, pertuzumab, and chemotherapy versus trastuzumab emtansine plus pertuzumab in patients with HER2-positive breast cancer (KRISTINE): a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol, 2018, 19(1): 115-126.
11.	van Ramshorst MS, van Werkhoven E, Honkoop AH, et al. Toxicity of dual HER2-blockade with pertuzumab added to anthracycline versus non-anthracycline containing chemotherapy as neoadjuvant treatment in HER2-positive breast cancer: The TRAIN-2 study. Breast, 2016, 29: 153-159.
12.	Hurvitz SA, Martin M, Jung KH, et al. Neoadjuvant trastuzumab emtansine and pertuzumab in human epidermal growth factor receptor 2-positive breast cancer: three-year outcomes from the phase Ⅲ KRISTINE study. J Clin Oncol, 2019, 37(25): 2206-2216.
13.	Schneeweiss A, Chia S, Hickish T, et al. Long-term efficacy analysis of the randomised, phase Ⅱ TRYPHAENA cardiac safety study: Evaluating pertuzumab and trastuzumab plus standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer. Eur J Cancer, 2018, 89: 27-35.
14.	van Ramshorst MS, van der Voort A, van Werkhoven ED, et al. Neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2 blockade for HER2-positive breast cancer (TRAIN-2): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol, 2018, 19(12): 1630-1640.
15.	谭惠文, 李佳琦, 余叶蓉, 等. 多学科专家团队模式在垂体瘤及相关疾病诊疗中的应用. 华西医学, 2018, 33(12): 1526-1529.
16.	杨彬. 多学科模式在乳腺癌诊治中的实践及新进展. 中国医药导报, 2019, 16(26): 54-56, 63.
17.	Prabhakar CN, Fong KM, Peake MD, et al. The effectiveness of lung cancer MDT and the role of respiratory physicians. Respirology, 2015, 20(6): 884-888.
18.	王朋飞, 代伟娜, 刘礼新, 等. 多学科联合胸腔镜手术治疗肺癌的应用分析. 中国胸心血管外科临床杂志, 2019, 26(12): 1185-1189.
19.	Taylor C, Munro AJ, Glynne-Jones R, et al. Multidisciplinary team working in cancer: what is the evidence? BMJ, 2010, 340: c951.

1. 中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)乳腺癌诊疗指南(2019. V1). 北京: 人民卫生出版社, 2019.
2. Gianni L, Eiermann W, Semiglazov V, et al. Neoadjuvant and adjuvant trastuzumab in patients with HER2-positive locally advanced breast cancer (NOAH): follow-up of a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet Oncol, 2014, 15(6): 640-647.
3. Untch M, Thomssen C, Bauerfeind I, et al. Primary therapy of early breast cancer: Evidence, controversies, consensus: spectrum of opinion of German specialists on the 16th St. Gallen International Breast Cancer Conference (Vienna 2019). Geburtshilfe Frauenheilkd, 2019, 79(6): 591-604.
4. 中国乳腺癌新辅助治疗专家组. 中国乳腺癌新辅助治疗专家共识(2019 年版). 中国癌症杂志, 2019, 29(5): 390-400.
5. Gianni L, Pienkowski T, Im YH, et al. 5-year analysis of neoadjuvant pertuzumab and trastuzumab in patients with locally advanced, inflammatory, or early-stage HER2-positive breast cancer (NeoSphere): a multicentre, open-label, phase 2 randomised trial. Lancet Oncol, 2016, 17(6): 791-800.
6. 李文金. 乳癌新辅助化疗后 Ki-67 变化与临床疗效的关系. 齐鲁医学杂志, 2017, 32(1): 23-24, 27.
7. 中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)乳腺癌诊疗指南(2020. V1). 北京: 人民卫生出版社, 2020.
8. von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer. N Engl J Med, 2019, 380(7): 617-628.
9. Gianni L, Eiermann W, Semiglazov V, et al. Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet, 2010, 375(9712): 377-384.
10. Hurvitz SA, Martin M, Symmans WF, et al. Neoadjuvant trastuzumab, pertuzumab, and chemotherapy versus trastuzumab emtansine plus pertuzumab in patients with HER2-positive breast cancer (KRISTINE): a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol, 2018, 19(1): 115-126.
11. van Ramshorst MS, van Werkhoven E, Honkoop AH, et al. Toxicity of dual HER2-blockade with pertuzumab added to anthracycline versus non-anthracycline containing chemotherapy as neoadjuvant treatment in HER2-positive breast cancer: The TRAIN-2 study. Breast, 2016, 29: 153-159.
12. Hurvitz SA, Martin M, Jung KH, et al. Neoadjuvant trastuzumab emtansine and pertuzumab in human epidermal growth factor receptor 2-positive breast cancer: three-year outcomes from the phase Ⅲ KRISTINE study. J Clin Oncol, 2019, 37(25): 2206-2216.
13. Schneeweiss A, Chia S, Hickish T, et al. Long-term efficacy analysis of the randomised, phase Ⅱ TRYPHAENA cardiac safety study: Evaluating pertuzumab and trastuzumab plus standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer. Eur J Cancer, 2018, 89: 27-35.
14. van Ramshorst MS, van der Voort A, van Werkhoven ED, et al. Neoadjuvant chemotherapy with or without anthracyclines in the presence of dual HER2 blockade for HER2-positive breast cancer (TRAIN-2): a multicentre, open-label, randomised, phase 3 trial. Lancet Oncol, 2018, 19(12): 1630-1640.
15. 谭惠文, 李佳琦, 余叶蓉, 等. 多学科专家团队模式在垂体瘤及相关疾病诊疗中的应用. 华西医学, 2018, 33(12): 1526-1529.
16. 杨彬. 多学科模式在乳腺癌诊治中的实践及新进展. 中国医药导报, 2019, 16(26): 54-56, 63.
17. Prabhakar CN, Fong KM, Peake MD, et al. The effectiveness of lung cancer MDT and the role of respiratory physicians. Respirology, 2015, 20(6): 884-888.
18. 王朋飞, 代伟娜, 刘礼新, 等. 多学科联合胸腔镜手术治疗肺癌的应用分析. 中国胸心血管外科临床杂志, 2019, 26(12): 1185-1189.
19. Taylor C, Munro AJ, Glynne-Jones R, et al. Multidisciplinary team working in cancer: what is the evidence? BMJ, 2010, 340: c951.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

MDT discussion and rethink of comprehensive treatment for 2 cases of HER-2 positive breast cancer

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