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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

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    Authors
    Jackisch, C.
    Cortazar, P.
    Geyer, C. E.
    Gianni, L.
    Gligorov, J.
    Machackova, Z.
    Perez, E. A.
    Schneeweiss, A.
    Tolaney, S. M.
    Untch, M.
    Wardley, Andrew M
    Piccart, M.
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    Affiliation
    AGO-B and Sana Klinikum Offenbach GmbH, Offenbach, Germany
    Issue Date
    2021
    
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    Abstract
    Treatment of HER2-positive early breast cancer (EBC) continues to evolve with neoadjuvant (pre-operative) and adjuvant (post-operative) HER2-targeted therapies as standard of care. There are two important decision points. The first involves deciding between neoadjuvant therapy or proceeding directly to surgery. Neoadjuvant chemotherapy (NACT) plus pertuzumab-trastuzumab is appropriate for patients with high-risk HER2-positive EBC (tumour diameter ≥2 cm, and/or node-positive disease). Patients with node-negative disease and tumour diameter <2 cm are candidates for upfront surgery followed by paclitaxel for 12 weeks plus 18 cycles of trastuzumab, with the option to add pertuzumab (if pN+). The second decision point involves the pathohistological result at surgery after neoadjuvant therapy. Total pathological complete response (tpCR: ypT0/is, ypN0) is associated with improved survival endpoints. Patients with tumours ≥2 cm and/or node-positive disease at diagnosis who have a tpCR after dual blockade should continue pertuzumab-trastuzumab in the adjuvant setting to complete 1 year (18cycles) of treatment. For patients with invasive residual disease, 14cycles of post-neoadjuvant trastuzumab emtansine (T-DM1) therapy significantly increases invasive-DFS compared with trastuzumab. Extended adjuvant therapy with neratinib is an option in selected patients (HER2-positive and oestrogen receptor [ER]-positive) who have completed adjuvant trastuzumab-based therapy. Less aggressive chemotherapy regimens are recommended in populations with a lower risk of recurrence (patients with small tumours without axillary involvement; patients unlikely to tolerate anthracycline-taxane or taxane-carboplatin regimens). Ultimately, treatment recommendations should be consistent with local and international guidelines. Further studies will guide optimisation of treatment for patients with HER2-positive EBC according to the risk of disease recurrence.
    Citation
    Jackisch C, Cortazar P, Geyer CE Jr, Gianni L, Gligorov J, Machackova Z, et al. Risk-based decision-making in the treatment of HER2-positive early breast cancer: Recommendations based on the current state of knowledge. Cancer Treatment Reviews. 2021 Sep;99:102229.
    Journal
    Cancer Treatment Reviews
    URI
    http://hdl.handle.net/10541/624654
    DOI
    10.1016/j.ctrv.2021.102229
    PubMed ID
    34139476
    Additional Links
    https://dx.doi.org/10.1016/j.ctrv.2021.102229
    Type
    Article
    Language
    en
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ctrv.2021.102229
    Scopus Count
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    All Paterson Institute for Cancer Research

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