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. 2023 Sep 29;3(4):266-272.
doi: 10.1016/j.jncc.2023.09.002. eCollection 2023 Dec.

Consensus on clinical diagnosis and medical treatment of HER2-low breast cancer (2022 edition)

Bu Hong  1 , Fan Ying  2 , Fan Zhaoqing  3 , Hu Xichun  4 , Li Man  5 , Li Qiao  2 , Liao Ning  6 , Luo Ting  7 , Nie Jianyun  8 , Pan Yueyin  9 , Qi Xiaowei  10 , Shao Zhimin  11 , Song Guohong  12 , Sun Tao  13 , Teng Yue-E  14 , Tong Zhongsheng  15 , Wang Jiayu  2 , Wang Shusen  16 , Wang Xue  17 , Wang Yongsheng  18 , Wang Zhonghua  11 , Xu Binghe  19 , Xu Ling  20 , Xue Yan  21 , Yang Wentao  22 , Yao Herui  23 , Ying Jianming  24 , Yuan Peng  17 , Zhang Jian  4 , Zhang Qingyuan  25 , Zhang Yongqiang  26 , Zhao Jiuda  27
Affiliations

Consensus on clinical diagnosis and medical treatment of HER2-low breast cancer (2022 edition)

Bu Hong et al. J Natl Cancer Cent. .

Abstract

Treatment of breast cancer with low expression of human epidermal growth factor receptor 2 (HER2; HER2-low) has drawn much attention in recent years. With the proven therapeutic effect of trastuzumab deruxtecan (T-DXd) in patients with HER2-low (immunohistochemistry [IHC] 1+, or IHC2+/in situ hybridization [ISH]-) breast cancer, HER2-low may become a new subtype of targeted therapy for breast cancer. The expert committee formulated this consensus based on the current clinical studies and clinical medication experience. The current consensus is the collaborative work of an interdisciplinary working group, including experts in the fields of pathology and oncology. The purpose of this consensus was to guide the clinical diagnosis and treatment of HER2-low breast cancer, thereby prolonging the overall survival of patients.

Keywords: Antibody-drug conjugate; Breast cancer; HER2-low.

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Conflict of interest statement

The authors declare that they have no conflict of interests.

Figures

Fig 1
Fig. 1
Flowchart of HER2-low breast cancer evaluation. HER2, human epidermal growth factor receptor 2; IHC, immunohistochemistry; ISH, in situ hybrization.
Fig 2
Fig. 2
Treatment routines for patients with HER2-low HR+ advanced breast cancer. The full lines represent recommended treatments, while the dotted line represents optional treatment. a Endocrine therapy, including aromatizing enzyme inhibitors, estrogen receptor modulator, and tamoxifen. b Target therapy, including HDAC inhibitors, mTOR inhibitors, PI3K inhibitors (PIK3CA mutation), CDK4/6 inhibitors, and PARP inhibitors (e.g. gBRCA mutation). c Endocrine refractory populations, including populations with endocrine primary drug resistance, and advanced populations in whom two consecutive lines of endocrine therapy failed. CDK4/6i, CDK4/6 inhibitor; ET, endocrine therapy; HER2, human epidermal growth factor receptor 2; HR, hormone receptor; T-DXd, trastuzumab deruxtecan.
Fig 3
Fig. 3
Treatment routines for patients with HER2-low HR- advanced breast cancer. a Target therapy, including VEGF inhibitors and PARP inhibitors (gBRCA mutation); b For PD-L1-positive patients, anti-neoplastic immunotherapy concomitant with chemotherapy is available as the first-line treatment. HER2, human epidermal growth factor receptor 2; HR, hormone receptor; IO, tumor immunotherapy; PD-L1, programmed death ligand 1; T-DXd, trastuzumab deruxtecan; VEGF, vascular endothelial growth factor.
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