Pathological Complete Response with the 4AC-4THP Regimen in Neoadjuvant Treatment of HER2-Positive Breast Cancer: A Multicenter Retrospective Analysis in Vietnam
Abstract
Background: Evidence on the effectiveness of the 4AC–4THP neoadjuvant regimen in Vietnamese patients with HER2-positive breast cancer remains limited. This study aimed to evaluate the pathological response rates and associated clinical factors in patients treated with this regimen.
Methods: Data were retrospectively collected from medical records of 50 consecutive HER2-positive breast cancer patients who received neoadjuvant 4AC–4THP therapy at three institutions in northern Vietnam between January 2016 and October 2024. Pathological response was evaluated using Chevallier’s criteria, in which complete pathological response was defined as ypT0/Tis ypN0.
Results: Fifty eligible HER2 positive breast cancer patients treated with 4AC- 4THP regimens in a neoadjuvant setting at Hanoi Medical University Hospital, Vietnam National Cancer Hospital and Hanoi Oncology Hospital were included in the analysis. Median age was 41 (range 26 – 67 years). Of these 50 patients, 41 (82%) were premenopausal, while 9 (18%) were postmenopausal; 21 patients (42%) had hormone receptor-positive. The overall clinical complete response (cCR) rate for both tumors and lymph nodes was 56% (23 out of 50). The total pathological complete response (pCR) rate was 78% (39 out of 50). Breast pCR (bpCR) was achieved in 40 out of 50 patients (80%) for breast tumors and nodal pCR (npCR) was achieved in 32 out of 34 patients (94.1%) for lymph nodes. There was no significant association between pCR rate and age, tumor grade, lymph node stage, disease stage and hormone receptor status (p>0.05, with all ORs and 95%Cis crossed unity).
Conclusion: The 4AC-4THP regimen in neoadjuvant treatment for HER2-positive breast cancer has shown high therapeutic efficacy, achieving a pCR rate of 78.0%.
Full text article
References
Cancer Today. Accessed April 5, 2025. https://gco.iarc.who.int/today/
Leung K. Cy5.5-8-Amino-octanoic acid-Ser-Cys-Pro-Pro-Trp-Gln-Glu-Trp-His-Asn-Phe-Met-Pro-Phe-NH2. In: Molecular Imaging and Contrast Agent Database (MICAD). National Center for Biotechnology Information (US); 2004. Accessed April 5, 2025. http://www.ncbi.nlm.nih.gov/books/NBK114193/
Dowling GP, Keelan S, Toomey S, Daly GR, Hennessy BT, Hill ADK. Review of the status of neoadjuvant therapy in HER2-positive breast cancer. Front Oncol. 2023;13:1066007. doi:10.3389/fonc.2023.1066007
Wuerstlein R, Harbeck N. Neoadjuvant Therapy for HER2-positive Breast Cancer. Rev Recent Clin Trials. 2017;12(2):81-92. doi:10.2174/1574887112666170202165049
Cortazar P, Zhang L, Untch M, et al. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet Lond Engl. 2014;384(9938):164-172. doi:10.1016/S0140-6736(13)62422-8
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. doi:10.1016/S1470-2045(14)70080-4
Untch M, Fasching PA, Konecny GE, et al. Pathologic complete response after neoadjuvant chemotherapy plus trastuzumab predicts favorable survival in human epidermal growth factor receptor 2-overexpressing breast cancer: results from the TECHNO trial of the AGO and GBG study groups. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29(25):3351-3357. doi:10.1200/JCO.2010.31.4930
Untch M, Rezai M, Loibl S, et al. Neoadjuvant treatment with trastuzumab in HER2-positive breast cancer: results from the GeparQuattro study. J Clin Oncol Off J Am Soc Clin Oncol. 2010;28(12):2024-2031. doi:10.1200/JCO.2009.23.8451
Nami B, Maadi H, Wang Z. Mechanisms Underlying the Action and Synergism of Trastuzumab and Pertuzumab in Targeting HER2-Positive Breast Cancer. Cancers. 2018;10(10):342. doi:10.3390/cancers10100342
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. doi:10.1016/S1470-2045(16)00163-7
Swain SM, Baselga J, Kim SB, et al. Pertuzumab, trastuzumab, and docetaxel in HER2-positive metastatic breast cancer. N Engl J Med. 2015;372(8):724-734. doi:10.1056/NEJMoa1413513
Giordano SH, Franzoi MAB, Temin S, et al. Systemic Therapy for Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer: ASCO Guideline Update. J Clin Oncol Off J Am Soc Clin Oncol. 2022;40(23):2612-2635. doi:10.1200/JCO.22.00519
Hoang TH, Thi HTP. 15P HER2-positive breast cancer in a low-middle income country (LMIC): Lack of pathology capability and the urgent need for targeted treatment. Ann Oncol. 2024;35:S1410. doi:10.1016/j.annonc.2024.10.035
Wolff AC, Hammond MEH, Allison KH, et al. Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. Arch Pathol Lab Med. 2018;142(11):1364-1382. doi:10.5858/arpa.2018-0902-SA
Popa CN, Bîrlă R, Daniela D, Iosif C, Chirita E, Mateș IN. Predictive Factors of Neoadjuvant Chemotherapy Response in Breast Cancer Validated by Three Anatomopathological Scores: Residual Cancer Burden, Chevallier System, and Tumor-Infiltrating Lymphocytes. Cureus. 16(4):e59391. doi:10.7759/cureus.59391
Davey MG, Browne F, Miller N, Lowery AJ, Kerin MJ. Pathological complete response as a surrogate to improved survival in human epidermal growth factor receptor-2-positive breast cancer: systematic review and meta-analysis. BJS Open. 2022;6(3):zrac028. doi:10.1093/bjsopen/zrac028
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 Oxf Engl 1990. 2018;89:27-35. doi:10.1016/j.ejca.2017.10.021
Phung HT, Nguyen HT, Nguyen TV, Nguyen TV, Dinh LAT, Nguyen CV. Pathological Complete Response with Neoadjuvant Trastuzumab Combined with Chemotherapy in HER2 Positive Breast Cancer: A Single Institution Retrospective Analysis from Vietnam. Breast Cancer Dove Med Press. 2020;12:117-122. doi:10.2147/BCTT.S268369
Phùng Thị Huyền. KẾT QUẢ ĐIỀU TRỊ BỔ TRỢ TRƯỚC PHÁC ĐỒ HÓA CHẤT KẾT HỢP TRASTUZUMAB VÀ PERTUZUMAB TRÊN UNG THƯ VÚ CÓ HER2-NEU DƯƠNG TÍNH | Tạp chí Y học Việt Nam. January 12, 2022. https://tapchiyhocvietnam.vn/index.php/vmj/article/view/1761
Authors
Copyright (c) 2025 Archives of Breast Cancer
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright©. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International License, which permits copy and redistribution of the material in any medium or format or adapt, remix, transform, and build upon the material for any purpose, except for commercial purposes.