Adjuvant systemic therapy for HER2-positive breast cancer
- Harold Burstein, MD, PhD
Harold Burstein, MD, PhD
- Section Editor — Breast Cancer
- Associate Professor of Medicine
- Harvard Medical School
Globally, breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in females. In the United States, breast cancer is the most common female cancer, the second most common cause of cancer death in women, and the main cause of death in women ages 40 to 49 years. The lifetime probability of developing invasive breast cancer is one in eight.
Breast cancer is a heterogeneous, phenotypically diverse disease composed of several biologic subtypes that have distinct behavior. Amplification or overexpression of the human epidermal growth factor receptor 2 (HER2) oncogene is present in approximately 15 percent of primary invasive breast cancers . Women with early-stage breast cancer that meet criteria for HER2 positivity are treated with chemotherapy and trastuzumab as adjuvant treatment.
This topic review will cover the use of adjuvant trastuzumab plus chemotherapy in patients with HER2-positive early stage breast cancer (stage I to III ). Where clinical guidance is provided in this topic, the anatomic staging system set forth in the eighth edition of the American Joint Committee on Cancer Staging Manual is used (table 1); however, it is recognized that the studies cited may have used previous editions of the staging system, which is a limitation of existing data. (See "Tumor, Node, Metastasis (TNM) staging classification for breast cancer".)
Principles of testing for HER2 expression on breast cancer tumor tissue is discussed elsewhere, as is adjuvant chemotherapy in other populations.
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- PATIENT ELIGIBILITY
- Indications for small HER2-positive tumors
- HER2-DIRECTED AGENTS
- TREATMENT OVERVIEW
- TRASTUZUMAB-BASED THERAPY
- Addition of pertuzumab for high-risk disease
- Prescribing information
- Treatment duration
- Choice of chemotherapy
- - Anthracycline-based therapy
- - Nonanthracycline-based therapy
- - Preferred regimen for small HER2-positive tumors
- SPECIAL POPULATIONS
- Male breast cancer
- Breast cancer in pregnancy
- Patients with cardiac risk factors
- Patients who were treated with neoadjuvant therapy
- ASSESSING RISKS AND BENEFITS OF TREATMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS