Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Mar;62 Suppl 1(Suppl 1):S12-S16.
doi: 10.1016/j.breast.2022.01.006. Epub 2022 Jan 19.

Neoadjuvant and adjuvant treatment of patients with HER2-positive early breast cancer

Nadia Harbeck  1
Affiliations
Meta-Analysis

Neoadjuvant and adjuvant treatment of patients with HER2-positive early breast cancer

Nadia Harbeck. Breast. 2022 Mar.

Abstract

The availability of HER2-targeted therapy has dramatically improved patient outcome in HER2-positive (HER2+) early breast cancer (EBC) as recently demonstrated by the EBCTCTG metaanalysis on trastuzumab in HER2+ EBC: Adding trastuzumab to chemotherapy has reduced recurrence rates and breast-cancer related mortality by a third [1]. Today, neoadjuvant therapy has become standard of care for women with stage II or III tumors as pathological complete response (pCR) status after surgery can be used to individualize adjuvant systemic therapy. pCR is correlated with favorable patient outcome, particularly in hormone receptor (HR) negative HER2+ EBC, as demonstrated by the FDA meta-analysis. Moreover, for patients with non-pCR, 14 cycles of adjuvant T-DM1 have become a new adjuvant therapy standard based on the results of the KATHERINE trial. Primary surgery can be offered to patients with low tumor burden (cN0 cT1). For this low-risk subgroup, 12 weeks of adjuvant paclitaxel + trastuzumab for one year are correlated with excellent outcome based on the APT trial results. A multidisciplinary team is essential right from the beginning for optimal locoregional and systemic therapy in such a complex neoadjuvant - adjuvant continuum of care. Clinical trials in HER2+ EBC are currently evaluating further therapy de-escalation in low-risk disease or patients with pCR whereas for patients with non-pCR, escalation trials are also ongoing. Newly approved drugs for HER2+ MBC like tucatinib or trastuzumab-deruxtecan or even immunotherapy combinations are being evaluated to improve upon efficacy of T-DM1 alone in the non-pCR setting. Regarding de-escalation, the WSG ADAPT trial demonstrated feasibility of avoiding overtreatment and individualizing neoadjuvant therapy without compromising outcome. Further de-escalation trials (e.g. DECRESCENDO, COMPASS-HER2) are currently ongoing.

Keywords: HER2+ early breast cancer; Pertuzumab; T-DM1, neratinib; Trastuzumab.

PubMed Disclaimer

Conflict of interest statement

NH received honoraria for lectures and/or consulting from Astra Zeneca, Daiichi-Sankyo, Exact Sciences, Lilly, MSD, Novartis, Pierre Fabre, Pfizer, Roche, Sandoz, SeaGen, NH is a co-director of the West German Study Group.

Figures

Fig. 1
Fig. 1
Treatment algorithm in HER2-positive early breast cancer.
See this image and copyright information in PMC

References

    1. Early Breast Cancer Trialists’ Collaborative group (EBCTCG) Trastuzumab for early-stage, HER2-positive breast cancer: a meta-analysis of 13 864 women in seven randomised trials. Lancet Oncol. 2021;22(8):1139–1150. Aug. - PMC - PubMed
    1. Curigliano G., Burstein H.J., P Winer E., Gnant M., Dubsky P., Loibl S., Colleoni M., Regan M.M., Piccart-Gebhart M., Senn H.J., Thürlimann B. Panel members of the st. Gallen international expert consensus on the primary therapy of early breast cancer 2017. De-escalating and escalating treatments for early-stage breast cancer: the st. Gallen international expert consensus conference on the primary therapy of early breast cancer 2017. Ann Oncol. 2019;30(7):1181. Jul 1. - PMC - PubMed
    1. Burstein H.J., Curigliano G., Loibl S., Dubsky P., Gnant M., Poortmans P., Colleoni M., Denkert C., Piccart-Gebhart M., Regan M., Senn H.J., Winer E.P., Thurlimann B. Members of the st. Gallen international consensus panel on the primary therapy of early breast cancer 2019. Estimating the benefits of therapy for early-stage breast cancer: the st. Gallen international consensus guidelines for the primary therapy of early breast cancer 2019. Ann Oncol. 2019;30(10):1541–1557. Oct 1. - PubMed
    1. Burstein H.J., Curigliano G., Thürlimann B., Weber W.P., Poortmans P., Regan M.M., Senn H.J., Winer E.P., Gnant M. Panelists of the St Gallen Consensus Conference. Customizing local and systemic therapies for women with early breast cancer: the St. Gallen International Consensus Guidelines for treatment of early breast cancer 2021. Ann Oncol. 2021;32(10):1216–1235. Oct. - PMC - PubMed
    1. Harbeck N., Penault-Llorca F., Cortes J., Gnant M., Houssami N., Poortmans P., Ruddy K., Tsang J., Cardoso F. Breast cancer. Nat Rev Dis Prim. 2019;5(1):66. Sep. 23. - PubMed

Publication types