![]() Non-cross-resistance regimens are commonly used in the treatment of advanced breast cancer 6. Therefore, it remains controversial which chemotherapy regimen is superior and how many cycles of that regimen are appropriate for HR + /HER2-/LN+ patients. ![]() Hormone receptor-positive (HR + )/human epidermal growth factor receptor 2-negative (HER2-) breast cancer is known to be non-responsive to chemotherapy however, lymph node positivity (LN+ ) is an indicator for chemotherapy. The patients in the VbMF group had better survival outcomes. If the pathological response was poor, the patients were randomized to receive five cycles of CAVP or a combination of vincristine, bleomycin, methotrexate, and fluorouracil (VbMF). In their trial, all patients received three cycles of neoadjuvant CAVP. adapted this postoperative treatment strategy 5. Both trials failed to demonstrate a significant increase in the pCR rate after modification of treatment based on clinical response in patients who were non-responsive to NCT.Ĭompared to clinical response, administering additional treatments with different mechanisms based on pathological response may be a reasonable therapeutic approach. All responsive patients were randomized to receive four additional cycles of CAVP or docetaxel, whereas non-responsive patients received four cycles of docetaxel. 4 were administered NCT with four cycles of a combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CAVP), and clinical response was evaluated by physical examination after four cycles of NCT. All non-responsive patients were randomized to receive either four cycles of TAC or four cycles of vinorelbine plus capecitabine (NX) 3. The GeparTrio trial adjusted the NCT regimen based on ultrasound assessment after two cycles of a combination of docetaxel (Taxotere), doxorubicin hydrochloride (Adriamycin), and cyclophosphamide (TAC therapy). Two major RCTs have explored the advantages of altering ongoing NCT after an early assessment of the initial clinical response. Consequently, two strategies were established to overcome potential drug resistance the first was adding a new drug in the NCT setting to improve the pCR rate, and the second was adding a non-cross-resistant regimen in a selected population with a high recurrence risk (i.e., non-pCR patients). Although no survival benefit has been found with neoadjuvant chemotherapy (NCT), these trials have demonstrated that the pathological complete response (pCR) was associated with better survival. Previous randomized controlled trials (RCTs) have failed to illustrate a significant difference in survival outcomes between using the same chemotherapy regimen in neoadjuvant and adjuvant settings 1, 2. For patients non-responsive to neoadjuvant chemotherapy, adjuvant non-cross-resistant chemotherapy did not significantly improve distant disease-free survival compared to ET alone. Comparatively, the observation group showed a trend towards better distant disease-free survival. After a median follow-up period of 72.4 months, the 5-year distant disease-free survival was 92% and 90% in the chemotherapy plus ET and ET-alone groups, respectively. The final intention-to-treat analysis comprised 379 patients. Distant disease-free survival was the primary endpoint. Forty patients responsive to neoadjuvant chemotherapy and with Miller and Payne G4 or G5 and LN- status were assigned to the observation group. Patients received four cycles of non-cross-resistant adjuvant chemotherapy plus endocrine therapy (ET), or ET alone. There are few studies focus on post-neoadjuvant treatment in hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-)/lymph node-positive (LN+) breast cancer, a multi-center, open-label, randomized, controlled phase III trial was conducted to evaluate pathological response-guided non-cross-resistant adjuvant chemotherapy in patients with HR+/HER2-/LN+ breast cancer who were non-responsive to primary chemotherapy.
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