TY - JOUR
T1 - Risk-based decision-making in the treatment of HER2-positive early breast cancer
T2 - Recommendations based on the current state of knowledge
AU - Jackisch, Christian
AU - Cortazar, Patricia
AU - Geyer, Charles E.
AU - Gianni, Luca
AU - Gligorov, Joseph
AU - Machackova, Zuzana
AU - Perez, Edith A.
AU - Schneeweiss, Andreas
AU - Tolaney, Sara M.
AU - Untch, Michael
AU - Wardley, Andrew
AU - Piccart, Martine
N1 - Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.
PY - 2021/9
Y1 - 2021/9
N2 - Treatment of HER2-positive early breast cancer (EBC) continues to evolve with neoadjuvant (pre-operative) and adjuvant (post-operative) HER2-targeted therapies as standard of care. There are two important decision points. The first involves deciding between neoadjuvant therapy or proceeding directly to surgery. Neoadjuvant chemotherapy (NACT) plus pertuzumab–trastuzumab is appropriate for patients with high-risk HER2-positive EBC (tumour diameter ≥2 cm, and/or node-positive disease). Patients with node-negative disease and tumour diameter <2 cm are candidates for upfront surgery followed by paclitaxel for 12 weeks plus 18 cycles of trastuzumab, with the option to add pertuzumab (if pN+). The second decision point involves the pathohistological result at surgery after neoadjuvant therapy. Total pathological complete response (tpCR: ypT0/is, ypN0) is associated with improved survival endpoints. Patients with tumours ≥2 cm and/or node-positive disease at diagnosis who have a tpCR after dual blockade should continue pertuzumab–trastuzumab in the adjuvant setting to complete 1 year (18 cycles) of treatment. For patients with invasive residual disease, 14 cycles of post-neoadjuvant trastuzumab emtansine (T-DM1) therapy significantly increases invasive-DFS compared with trastuzumab. Extended adjuvant therapy with neratinib is an option in selected patients (HER2-positive and oestrogen receptor [ER]-positive) who have completed adjuvant trastuzumab-based therapy. Less aggressive chemotherapy regimens are recommended in populations with a lower risk of recurrence (patients with small tumours without axillary involvement; patients unlikely to tolerate anthracycline-taxane or taxane-carboplatin regimens). Ultimately, treatment recommendations should be consistent with local and international guidelines. Further studies will guide optimisation of treatment for patients with HER2-positive EBC according to the risk of disease recurrence.
AB - Treatment of HER2-positive early breast cancer (EBC) continues to evolve with neoadjuvant (pre-operative) and adjuvant (post-operative) HER2-targeted therapies as standard of care. There are two important decision points. The first involves deciding between neoadjuvant therapy or proceeding directly to surgery. Neoadjuvant chemotherapy (NACT) plus pertuzumab–trastuzumab is appropriate for patients with high-risk HER2-positive EBC (tumour diameter ≥2 cm, and/or node-positive disease). Patients with node-negative disease and tumour diameter <2 cm are candidates for upfront surgery followed by paclitaxel for 12 weeks plus 18 cycles of trastuzumab, with the option to add pertuzumab (if pN+). The second decision point involves the pathohistological result at surgery after neoadjuvant therapy. Total pathological complete response (tpCR: ypT0/is, ypN0) is associated with improved survival endpoints. Patients with tumours ≥2 cm and/or node-positive disease at diagnosis who have a tpCR after dual blockade should continue pertuzumab–trastuzumab in the adjuvant setting to complete 1 year (18 cycles) of treatment. For patients with invasive residual disease, 14 cycles of post-neoadjuvant trastuzumab emtansine (T-DM1) therapy significantly increases invasive-DFS compared with trastuzumab. Extended adjuvant therapy with neratinib is an option in selected patients (HER2-positive and oestrogen receptor [ER]-positive) who have completed adjuvant trastuzumab-based therapy. Less aggressive chemotherapy regimens are recommended in populations with a lower risk of recurrence (patients with small tumours without axillary involvement; patients unlikely to tolerate anthracycline-taxane or taxane-carboplatin regimens). Ultimately, treatment recommendations should be consistent with local and international guidelines. Further studies will guide optimisation of treatment for patients with HER2-positive EBC according to the risk of disease recurrence.
KW - HER2-postive early breast cancer
KW - Neoadjuvant therapy
KW - Neratinib
KW - Pertuzumab
KW - T-DM1
KW - Trastuzumab
KW - Decision Making
KW - Humans
KW - Risk Factors
KW - Lymphatic Metastasis
KW - Receptor, ErbB-2/antagonists & inhibitors
KW - Randomized Controlled Trials as Topic
KW - Protein Kinase Inhibitors/administration & dosage
KW - Clinical Trials, Phase III as Topic
KW - Medical Oncology/standards
KW - Female
KW - Neoadjuvant Therapy
KW - Breast Neoplasms/drug therapy
KW - Clinical Trials, Phase I as Topic
KW - Clinical Trials, Phase II as Topic
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UR - http://www.scopus.com/inward/citedby.url?scp=85107715800&partnerID=8YFLogxK
U2 - 10.1016/j.ctrv.2021.102229
DO - 10.1016/j.ctrv.2021.102229
M3 - Review article
C2 - 34139476
AN - SCOPUS:85107715800
SN - 0305-7372
VL - 99
SP - 102229
JO - Cancer Treatment Reviews
JF - Cancer Treatment Reviews
M1 - 102229
ER -