Concurrent administration of anti-HER2 therapy and radiotherapy: Systematic review

Radiother Oncol. 2017 Aug;124(2):190-199. doi: 10.1016/j.radonc.2017.07.006. Epub 2017 Jul 24.


Background: Over the past few years, anti-HER2 targeted therapies have proven to be a key treatment in the management of human epidermal growth receptor 2 (HER2)-positive breast cancers, as well as gastrointestinal tract tumors and head and neck tumors. Anti-HER2 therapies administered alone or in combination with chemotherapy have been extensively studied, but only limited robust data are available concerning the safety and efficacy of anti-HER2 molecules in combination with radiotherapy.

Methods: We searched on Medline, Embase and Cochrane databases the articles providing data on the concomitant association between the antiHER2 therapies used in clinical practice (trastuzumab, pertuzumab, lapatinib and T-DM1) with radiotherapy. The articles were selected according to their pre-clinical and clinical relevance.

Results: The trastuzumab-irradiation combination is the most studied, with a focus on the cardiac toxicity. The combination of lapatinib-irradiation was particularly studied in the context of cerebral metastases of HER2-positive breast cancer. The data on pertuzumab and T-DM1 were poor and are mainly case reports.

Conclusion: To date, reliable conclusions about the toxicity and/or efficacy of concomitant irradiation with anti-HER2 therapies are difficult to make due to the heterogeneity of the data in the literature and need to be confirmed on a larger scale and long term follow-up. Nevertheless, no serious adverse events are reported and the toxicity profile seems to be manageable.

Keywords: Concomitant; Irradiation; Lapatinib; Pertuzumab; T-DM1; Trastuzumab.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / enzymology
  • Breast Neoplasms / pathology
  • Breast Neoplasms / radiotherapy*
  • Chemoradiotherapy
  • Female
  • Humans
  • Molecular Targeted Therapy
  • Protein Kinase Inhibitors / administration & dosage
  • Protein Kinase Inhibitors / therapeutic use*
  • Randomized Controlled Trials as Topic
  • Receptor, ErbB-2 / antagonists & inhibitors*


  • Protein Kinase Inhibitors
  • ERBB2 protein, human
  • Receptor, ErbB-2