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

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.

• Authors: Angela Esposito, Giulia Viale, Carmen Criscitiello, Giuseppe Curigliano
• Journal: Expert review of clinical pharmacology (Expert Rev Clin Pharmacol) Vol. 12 Issue 1 Pg. 9-16 (Jan 2019) ISSN: 1751-2441 [Electronic] England
• PMID: 30466330 (Publication Type: Journal Article, Review)

Chemical References

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

Topics

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