5.1.2 Preoperative Treatment of HER-2 Positive
For HER-2 positive breast cancer，the neoadjuvant regimen should include trastuzumab and cigars.NeoSphere study［3，4］enrolled 417 patients with locally advanced，inflammatory or early HER-2 positive operable breast cancer，randomly divided into 4 groups according to 1∶1∶1∶1，respectively receiving four cycle of neoadjuvant therapy：group A（trastuzumab+docetaxel），group B（trastuzumab+pertuzumab+docetaxel），group C（patotuzide+Anti-trastuzumab），group D（pertuzumab+docetaxel），preliminary results in 2011 showed that the pathological complete response（PCR）of group B was significantly higher than the other three groups，respectively 29.0%，45.8%，16.8%，24.0%.Subgroup analysis showed that hormone receptor-negative or node-negative patients benefited more.The 5-year long-term follow-up results of the study were published in 2016.The 5-year PFS rates were 81%，86%，73%，and 73%，respectively.Subgroup analysis showed that total pathological complete response（tPCR）was associated with progression-free survival.Of the 417 patients，94（23%）achieved tPCR with a 5-year PFS of 85%，compared with 323 patients.For patients who did not reach PCR，the 5-year PFS was 76%.Based on the results of this study，the new assisted dual-targeted combined purple shirt（TH+P）was recommended as a Class Ⅱ recommendation in the 2019 CSCO guidelines.
Table 1 2019 CSCO guidelines for preoperative neoadjuvant chemotherapy(https://www.daowen.com)
