A clinical perspective on escalating or de-escalating adjuvant therapy in HER2+ breast cancer

Expert Rev Clin Pharmacol. 2019 Jan;12(1):9-16. doi: 10.1080/17512433.2019.1552134. Epub 2018 Dec 4.

Abstract

Introduction: Patients with early HER2-positive breast cancer (BC) benefit from HER2-targeted systemic therapy. The endorsed standard adjuvant treatment for patients with early HER2-positive breast cancer is chemotherapy plus trastuzumab administered for 1 year. Areas covered: Several trials have investigated modifications of the standard treatment in terms of de-escalation by either shortening the duration or giving less resource-demanding regimens and in terms of escalation by either adding a second anti-HER2 agent or extending the duration of HER2-targeted treatment for more than 12 months. In this perspective, we would offer a comprehensive view of these trials and discuss their findings. Expert commentary: At the current state of knowledge, there are still open questions regarding the management of HER2+ BC patients, such as the most adequate duration of trastuzumab therapy, the optimal chemotherapy regimen that should be combined with trastuzumab, and the addition of a second anti-HER2 agent. Growing evidences suggest that some HER2+ BC patients may not need chemotherapy. If these patients could be recognized upfront, optimal response could potentially be reached with HER2-targeted therapy alone.

Keywords: Adjuvant trastuzumab duration; HER2-positive breast cancer; HER2-targeted therapy; breast cancer.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage*
  • Breast Neoplasms / drug therapy*
  • Breast Neoplasms / pathology
  • Chemotherapy, Adjuvant / methods
  • Female
  • Humans
  • Molecular Targeted Therapy
  • Receptor, ErbB-2 / metabolism
  • Trastuzumab / administration & dosage*

Substances

  • ERBB2 protein, human
  • Receptor, ErbB-2
  • Trastuzumab