Risk-based decision-making in the treatment of HER2-positive early breast cancer: Recommendations based on the current state of knowledge

Jackisch, Christian; Cortazar, Patricia; Geyer, Charles E.; Gianni, Luca; Gligorov, Joseph; Machackova, Zuzana; Perez, Edith A.; Schneeweiß, Andreas; Tolaney, Sara M.; Untch, Michael; Wardley, Andrew M; Piccart, Martine

doi:10.1016/j.ctrv.2021.102229

Cited by 19 publications

(20 citation statements)

References 97 publications

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“…Perhaps, the key for this risk-adapted strategy relies, not only on estimating the overall risk of recurrence but on selecting high risk patients according to their biological driver. Therefore, de-escalating molecular stratified strategies may avoid unnecessary toxicities without compromising outcomes [32,33].…”

Section: Post-neoadjuvant Guided Therapymentioning

confidence: 99%

HER2+ Breast Cancer Escalation and De-Escalation Trial Design: Potential Role of Intrinsic Subtyping

Muíño¹,

Martín

Monte-Millán

et al. 2022

Cancers

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Long-term outcomes in breast cancer patients differ based on the molecular subtype, with HER2-E being the most aggressive one. Advances in clinical practice have dramatically shifted HER2+ breast cancer prognosis. Risk adapted strategies to individualize therapies are necessary. De-escalation approaches have been encouraged based on the risks of clinical-pathological factors. Molecular gene subtyping could further accurately define HER2 addicted tumours that are sensitive to anti-HER2 therapies, thus sparing unnecessary treatments. The transition from immunochemistry to molecular profiling in HER2+ breast cancer is discussed.

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Section: Post-neoadjuvant Guided Therapymentioning

confidence: 99%

HER2+ Breast Cancer Escalation and De-Escalation Trial Design: Potential Role of Intrinsic Subtyping

Muíño¹,

Martín

Monte-Millán

et al. 2022

Cancers

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“…Любопытные результаты были получены в ходе другого мета-анализа, оценившего результаты 5 крупных неоадъювантных исследований при Her2-положительном раке: HannaH (NCT00950300), NeoSphere (NCT00545688), TRYPHAENA (NCT00976989), BERENICE (NCT02132949), и KRISTINE (NCT02131064) [16]. 1764 больных получили комбинации неоадъювантной и адъювантной химиотерапии с трастузумабом +/-пертузумабом.…”

Section: значение полной патоморфологической регрессии при Her2-положительном ракеunclassified

Role of Post-Neoadjuvant therapy with trastuzumab emtansine in HER2-positive breast cancer

Lubennikova

Vishnevskaya

2021

Medicinskij sovet

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The widespread introduction of anti-HER2 agents has changed the natural course of Her2-positive breast cancer. The use of trastuzumab, and later dual anti-HER2 blockade with pertuzumab, in neoadjuvant regimens significantly increased the chances of complete cure. However, among patients with early and locally advanced forms of Her2-positive cancer, there is a cohort with an extremely unfavorable prognosis – tumors that have not achieved complete pathomorphological regression after neoadjuvant chemotherapy.The presence of a residual tumor in Her2-positive breast cancer has long been only a prognostically unfavorable factor without the potential to influence disease outcome. The results of the international phase III study KATHERINE, which demonstrated the high efficacy of post-adjuvant therapy with trastuzumab emtansine (T-DM1) in this patient cohort, have established a new standard of care. Due to T-DM1 adjuvant therapy, the possibility to significantly improve long-term results determined the predictive characteristics of the morphological response to the choice of treatment tactics, which became an important argument in favor of neoadjuvant therapy in patients with not only locally advanced but also primarily resectable Her2-positive breast cancer, followed by personalization of therapy.This article presents our own experience with post-neoadjuvant therapy with trastuzumab emtansine in a young patient with a residual tumor. The data of the main studies in early Her2-positive breast cancer are summarized.

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“…Despite the undoubted benefit of adjuvant therapy, several clinical questions remain open. Approximately 25% of patients still experience recurrence up to 10 years from diagnosis, and further research efforts are needed to better refine patient selection for adopting escalation or de-escalation treatment strategies 2,3 .…”

Section: Introductionmentioning

confidence: 99%

PREDICT underestimates survival of patients with HER2-positive early-stage breast cancer

et al. 2022

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The prognostic performance of PREDICT in patients with HER2-positive early breast cancer (EBC) treated in the modern era with effective chemotherapy and anti-HER2 targeted therapies is unclear. Therefore, we investigated its prognostic performance using data extracted from ALTTO, a phase III trial evaluating adjuvant lapatinib ± trastuzumab vs. trastuzumab alone in patients with HER2-positive EBC. Our analysis included 2794 patients. After a median follow-up of 6.0 years (IQR, 5.8–6.7), 182 deaths were observed. Overall, PREDICT underestimated 5-year OS by 6.7% (95% CI, 5.8–7.6): observed 5-year OS was 94.7% vs. predicted 88.0%. The underestimation was consistent across all subgroups, including those according to the type of anti HER2-therapy. The highest absolute differences were observed for patients with hormone receptor negative-disease, nodal involvement, and large tumor size (13.0%, 15.8%, and 15.3%, respectively). AUC under the ROC curve was 73.7% (95% CI 69.7–77.8) in the overall population, ranging between 61.7% and 77.7% across the analyzed subgroups. In conclusion, our analysis showed that PREDICT highly underestimated OS in HER2-positive EBC. Hence, it should be used with caution to give prognostic estimation to HER2-positive EBC patients treated in the modern era with effective chemotherapy and anti-HER2 targeted therapies.

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Risk-based decision-making in the treatment of HER2-positive early breast cancer: Recommendations based on the current state of knowledge

Abstract: Risk-based decision-making in the treatment of HER2-positive early breast cancer: Recommendations based on the current state of knowledge, Cancer Treatment Reviews Cancer Treatment Reviews (2021), doi:

Cited by 19 publications

References 97 publications

HER2+ Breast Cancer Escalation and De-Escalation Trial Design: Potential Role of Intrinsic Subtyping

HER2+ Breast Cancer Escalation and De-Escalation Trial Design: Potential Role of Intrinsic Subtyping

Role of Post-Neoadjuvant therapy with trastuzumab emtansine in HER2-positive breast cancer

PREDICT underestimates survival of patients with HER2-positive early-stage breast cancer

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