Info
HER2-positive disease-of-localized breast cancer
Anti-HER2 agents approved in (neo) adj. setting Trastuzumab (Herceptin, H): Recombinant, humanized mAb binds to extracellular HER2 domain Pertuzumab (P): MAb, inhibits HER2 dimerization T-DM1: Antibody-drug conjugate of trastuzumab + antimicrotubule agent Duration: 6 mos of H not noninferior to 12 (PHARE, Lancet Oncol 2013;14:741, PERSPHONE trial. Lancet 2019;393:2599-2612); 24 mos = 12 mos (HERA, Lancet 2013;382:1021) Toxicities: Cardiac, NYHA III-IV or G3-4 cardiac events <4%. Risk ↑ if pretreated w/ anthracycline. Addition of P: No further ↑ in risk Echo/MUGA at baseline, postanthracycline, & serially every 3 mos. If symptomatic ↓ in EF or asx ↓ EF ≥ 10% below LLN or ≥ 16%, hold H Stage I: TH followed by H in T1b/c, consider for T1a cStage II-III: NAC is rec. ddACT-THP or TCbHP (taxane/carbo + HP) Addition of P: ↑ pCR (46% v. 29%) (NeoSphere, Lancet Onc 2012;13:25) pCR ∼ 60% w/ HP + anthra & T, no ↑ cardiotox (TRYPHAENA, Ann Oncol 2013;24:2278; BERENICE, ESMO Breast 2021) Anthracycline-free regimen: TCbHP every 3 wks × 9 cycles. pCR rate & 3 y EFS of TCbHP ≈ FEC - TCbHP (TRAIN2, JAMA Onc 2021;7:978-984) If non-PCR: T-DM1 for 14 cycles (KATHERINE, NEJM 2019;380:617-628) pStage II-III: After surgery → adj. AC-THP (APHINITY, NEJM 2017;377:122-131)
Siblings
- Local management with surgery and radiation-of-localized breast cancer
- Chemotherapy regimens for NAV or ADJ use in HR positive and TNBC-of-localized breast cancer
- Hormone positive disease-adjuvant endocrine treatment
- Hormone-positive disease-neoadjuvant therapy-of-localized breast cancer
- HER2-positive disease-of-localized breast cancer
- Considerations for young patients-of-localized breast cancer