Clinical efficacy of dual HER2 blockade in HER2-positive breast cancer
Martyniuk O.M., Smolanka I.I. , Chapyk I.I.
Summary. Objective. To evaluate the efficacy of different dual HER2 blockade strategies based on individual risk profiles, using illustrative clinical cases of patients with HER2-positive breast cancer. The object and methods. Four clinical cases of patients with HER2-positive breast cancer who received neoadjuvant or systemic therapy with dual HER2 blockade (trastuzumab + pertuzumab) combined with different chemotherapy regimens are presented. Treatment strategy was selected based on disease stage, tumor biological subtype, cardiovascular status, and clinical risk. Results. A pronounced antitumor response to dual HER2 blockade was recorded in all four clinical cases. Three patients with locally advanced and locoregionally advanced (including inflammatory) breast cancer achieved pathologic complete response (pCR, RCB — 0) after completion of neoadjuvant therapy. Specifically, in a patient with cardiac limitations, the anthracycline-free regimen TCbHP (docetaxel + carboplatin + trastuzumab + pertuzumab) enabled pCR without clinically significant cardiac function deterioration. In the escalation case, an anthracycline-containing regimen (AC → T + trastuzumab + pertuzumab) also resulted in complete pathologic response in a patient with an aggressive biological phenotype. In the fourth case — metastatic HER2-positive breast cancer with liver involvement — dual HER2 blockade combined with docetaxel (pertuzumab + trastuzumab + docetaxel) provided a marked partial response after only three cycles of therapy. Conclusions. Dual HER2 blockade combined with chemotherapy is a highly effective treatment strategy for HER2-positive breast cancer at various disease stages. Individualized selection of therapy regimen, considering oncological risk, cardiovascular status, and clinical context, allows achieving pathologic complete response with both anthracycline-free and anthracycline-containing approaches. In locally advanced disease, a multimodal strategy ensures adequate oncological control and creates prerequisites for reconstructive procedures.
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