HER2-positive breast cancer
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Genetics
- see breast cancer
- HER2/NEU proto-oncogene
- overexpression in 15-25% of cases
- overexpression predicts more aggressive disease
Laboratory
- see breast cancer
- immunocytochemistry: HER2/neu in tissue
- FISH or PCR/southern blot/northern blot/ISH for HER2/neu
Radiology
- see breast cancer
- neuroimaging for brain metastases if neurologic symptoms
- not routinely recommended
Management
- see breast cancer
- treatment targeting HER2 unless congestive heart failure
- 1st line therapy
- combination of trastuzumab, pertuzumab, & a taxane
- 2nd line therapy: trastuzumab (inferior to combination)[4]
- trastuzumab, lapatinib, pertuzumab have improved outcomes
- addition of pertuzumab to trastuzumab & docetaxel results in median survival of 56 months vs 41 months[3]
- neratinib plus capecitabine[2]
- up to 240 mg/day of neratinib plus 1500 mg/m2 per day of capecitabine (maximum tolerated dose)
- useful for patients with progressive HER2 metastatic disease following trastuzumab & taxane therapy
- median progression-free survival 36-40 weeks
- most common adverse events were diarrhea (88%) & hand-foot syndrome (48%)
- 1st line therapy
More general terms
Additional terms
References
- ↑ Giordano SH et al Systemic Therapy for Patients With Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. May 5, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24799465 <Internet> http://jco.ascopubs.org/content/early/2014/05/05/JCO.2013.54.0948.abstract
Ramakrishna N et al Recommendations on Disease Management for Patients With Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer and Brain Metastases: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. May 5, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24799487 <Internet> http://jco.ascopubs.org/content/early/2014/05/05/JCO.2013.54.0955.abstract - ↑ 2.0 2.1 Gradishar WJ Neratinib for Metastatic HER2 Breast Cancer. NEJM Journal Watch. Nov 3, 2014 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Saura C et al. Safety and efficacy of neratinib in combination with capecitabine in patients with metastatic human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol 2014 Oct 6 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25287822 <Internet> http://jco.ascopubs.org/content/early/2014/10/03/JCO.2014.56.3809 - ↑ 3.0 3.1 Nelson R New Standard of Care in HER2-Positive Metastatic Breast Cancer. Medscape Oncology. Feb 20, 2015 http://www.medscape.com/viewarticle/840080
- ↑ 4.0 4.1 Sawaki M et al. Randomized controlled trial of trastuzumab with or without chemotherapy for HER2-positive early breast cancer in older patients. J Clin Oncol 2020 Sep 16; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32936713 https://ascopubs.org/doi/10.1200/JCO.20.00184
de Azambuja et al. Are we RESPECTing older patient with breast cancer? J Clin Oncol 2020 Sep 16 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32936714 https://ascopubs.org/doi/10.1200/JCO.20.02329