We did not recommend neoadjuvant chemotherapy to the patient because of her clinical stage. The surgery was scheduled a month later, but the patient had concerns regarding the potential for the cancer to progress during the waiting period before the surgery and wanted to receive some kind of drug therapy. Here, we report the case of a patient with a dramatic response to an anti-HER2 drug. Although the rate of pCR was only 16.8% (95% CI: 10.3–25.3), it can be expected that a certain population will have a superior response to anti-HER2 drugs. The rate of pathological complete response (pCR) in the breast was lower in the trastuzumab + pertuzumab group than that in the combination group. In the NeoSphere trial, the efficacy of treatment was compared between patients treated with anti-HER2 drugs alone (trastuzumab + pertuzumab) and those treated with anti-HER2 drugs combined with chemotherapy (combination group). Moreover, monotherapy resulted in fewer adverse events and a more favorable health-related quality of life than trastuzumab + chemotherapy. In the RESPECT study comparing trastuzumab monotherapy with trastuzumab + chemotherapy after surgery, disease-free survival did not meet the hazard ratio, but the loss of observed survival for monotherapy was < 1 month at 3 years. Recently, de-escalation therapy without chemotherapy has been considered to reduce the adverse effects of treatment in the elderly population. However, chemotherapy may be harmful to elderly patients. In elderly patients, the aim of treatment is to achieve a beneficial effect with minimal harm. A standard systemic therapy for HER2-positive primary breast cancer is a combination of anti-HER2 therapy (e.g., trastuzumab or pertuzumab) and chemotherapy, which is associated with a higher response rate, as anti-HER2 therapy has significantly improved disease-free survival. Overexpression of the human epidermal growth factor receptor 2 (HER2) protein, amplification of the HER2 gene, or both, occurs in approximately 15–25% of breast cancers. In the future, identifying patients who are more likely to respond to trastuzumab, as in this case, will allow for more options regarding de-escalation therapy without chemotherapy, particularly in elderly patients who are concerned about the side effects of chemotherapy.īreast cancer is the most common cancer in women and one of the most common causes of death in this sex. This case suggests that trastuzumab monotherapy may be effective in certain patients with HER2-positive breast cancer. Postoperative treatment was limited to follow-up, and no recurrence was observed at 1 year and 6 months postoperatively. The patient refused further medication after surgery because of severe diarrhea after trastuzumab administration. Postoperative pathology showed no remnant of invasive carcinoma and pCR with only a 0.2-mm ductal carcinoma in situ remnant. Therefore, prior to surgery, one cycle of trastuzumab monotherapy was administered at the discretion of the attending physician. Mastectomy was scheduled within 2 months of the initial visit however, the patient was anxious about the length of the waiting period and requested medication in the interim. Vacuum-assisted breast biopsy, ultrasonography, and positron emission tomography–computed tomography revealed estrogen receptor-negative and HER2-positive, T1N0M0, stage I breast cancer. Case presentationĪn 88-year-old woman presented with a 2-cm palpable mass in the left breast. In this report, we describe our experience of dramatic anti-HER2 drug response in a patient who achieved pathological complete response (pCR) with a single dose of trastuzumab. Certain patient populations are expected to have a superior response to anti-HER2 drugs, particularly those with human epidermal growth factor receptor type 2 (HER2)-positive breast cancer. With advances in breast cancer treatment, the importance of de-escalation therapy to reduce harm during the treatment of elderly patients has attracted attention in recent years.
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