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Review
. 2020 Dec;15(6):560-569.
doi: 10.1159/000511883. Epub 2020 Oct 28.

Early HER2-Positive Breast Cancer: Current Treatment and Novel Approaches

Marija Ban  1 , Branka Petrić Miše  1 , Eduard Vrdoljak  1
Affiliations
Review

Early HER2-Positive Breast Cancer: Current Treatment and Novel Approaches

Marija Ban et al. Breast Care (Basel). 2020 Dec.

Abstract

Background: Trastuzumab significantly improves outcomes in early HER2-positive breast cancer, irrespectively of any prognostic or predictive factors. Unfortunately, about a quarter of patients receiving neoadjuvant trastuzumab experience disease recurrence, revealing the unquestionable need for further improvement of treatment outcomes.

Summary: Adding HER2 blockade to adjuvant trastuzumab with pertuzumab and neratinib improves invasive disease-free survival (IDFS), particularly for those at highest risk of recurrence. A shift toward a neoadjuvant strategy for patients with a higher risk of recurrence could result in further treatment optimization. For patients without a pathological complete response (pCR) after the neoadjuvant part of the therapy, a switch to adjuvant trastuzumab emtansine significantly improves IDFS and distant recurrence-free survival and shows a trend towards improved overall survival (OS). On the other hand, for low-risk patients, chemotherapy deescalation should be strongly considered with the use of trastuzumab monotherapy as an anti-HER2 backbone.

Key messages: Neoadjuvant therapy should be offered for a significant proportion of HER2-positive early breast cancer patients with a higher risk of recurrence. Postneoadjuvant treatment should be tailored according to the initial stage of disease and the response to neoadjuvant treatment.

Keywords: Early breast cancer; HER2 positivity; Neoadjuvant therapy.

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Conflict of interest statement

Marija Ban: speaker fees (Amgen, Novartis, Pfizer, Roche, and Merck). Eduard Vrdoljak: support for clinical trials and scientific projects (Pfizer, Roche, BMS, and AZ) and speaker fees and consulting (Amgen, Astellas, Astra Zeneca, Boehringer Ingelheim, Johnson & Johnson, Novartis, PharmaSwiss, Pfizer, Roche, Sanofi, MSD, and Merck). Branka Petrić Miše: Speaker fees and consulting (Amgen, Astra Zeneca, BMS, Novartis, Pfizer, Roche, Sanofi, and MSD).

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