Contents

Search

HER2-positive breast cancer

Genetics: - see breast cancer - HER2/NEU proto-oncogene a) overexpression in 15-25% of cases b) overexpression predicts more aggressive disease Laboratory: 1) see breast cancer 2) immunocytochemistry: HER2/neu in tissue 3) FISH or PCR/southern blot/northern blot/ISH for HER2/neu Radiology: - see breast cancer - neuroimaging for brain metastases if neurologic symptoms - not routinely recommended Management: - see breast cancer - treatment targeting HER2 unless congestive heart failure - 1st line therapy - combination of trastuzumab, pertuzumab, & a taxane - 2nd line therapy: trastuzumab (inferior to combination) [4] - trastuzumab, lapatinib, pertuzumab have improved outcomes - addition of pertuzumab to trastuzumab & docetaxel results in median survival of 56 months vs 41 months [3] - neratinib plus capecitabine [2] - up to 240 mg/day of neratinib plus 1500 mg/m2 per day of capecitabine (maximum tolerated dose) - useful for patients with progressive HER2 metastatic disease following trastuzumab & taxane therapy - median progression-free survival 36-40 weeks - most common adverse events were diarrhea (88%) & hand-foot syndrome (48%)

Related

receptor tyrosine-protein kinase erbB-2; p185erbB2; C-erbB-2; NEU proto-oncogene; tyrosine kinase-type cell surface receptor HER2; MLN 19; CD340 (ERBB2, HER2, NEU, NGL)

General

breast cancer

References

  1. Giordano SH et al Systemic Therapy for Patients With Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. May 5, 2014 PMID: 24799465 http://jco.ascopubs.org/content/early/2014/05/05/JCO.2013.54.0948.abstract - Ramakrishna N et al Recommendations on Disease Management for Patients With Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer and Brain Metastases: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. May 5, 2014 PMID: 24799487 http://jco.ascopubs.org/content/early/2014/05/05/JCO.2013.54.0955.abstract
  2. Gradishar WJ Neratinib for Metastatic HER2 Breast Cancer. NEJM Journal Watch. Nov 3, 2014 Massachusetts Medical Society (subscription needed) http://www.jwatch.org - Saura C et al. Safety and efficacy of neratinib in combination with capecitabine in patients with metastatic human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol 2014 Oct 6 PMID: 25287822 http://jco.ascopubs.org/content/early/2014/10/03/JCO.2014.56.3809
  3. Nelson R New Standard of Care in HER2-Positive Metastatic Breast Cancer. Medscape Oncology. Feb 20, 2015 http://www.medscape.com/viewarticle/840080
  4. Sawaki M et al. Randomized controlled trial of trastuzumab with or without chemotherapy for HER2-positive early breast cancer in older patients. J Clin Oncol 2020 Sep 16; [e-pub]. PMID: 32936713 https://ascopubs.org/doi/10.1200/JCO.20.00184 - de Azambuja et al. Are we RESPECTing older patient with breast cancer? J Clin Oncol 2020 Sep 16 PMID: 32936714 https://ascopubs.org/doi/10.1200/JCO.20.02329