Optimizing the management of HER2-positive early breast cancer: the clinical reality

Su. Verma, S. Lavasani, J. Mackey, K. Pritchard, M. Clemons, S. Dent, J. Latreille, J. Lemieux, L. Provencher, Sh. Verma, S. Chia, B. Wang, D. Rayson


Breast cancer positive for HER2 (human epidermal growth factor receptor 2) is associated with a poor prognosis for patients with both early-stage and metastatic breast cancer. Trastuzumab has been shown to be effective and is now considered the standard of care for early-stage patients with HER2-positive breast cancer. In that population, trastuzumab has been studied in six randomized clinical trials. Over­all, use of this agent leads to a significant reduction in risk of disease recurrence and improvement in overall survival. Despite the strong evidence for the use of trastuzumab in managing HER2-positive early breast cancer (EBC), a number of clinical controver­sies remain. The authors of this paper undertook a review of the available scientific literature on adju­vant trastuzumab to produce practical considerations from Canadian oncologists. The panel focused their discussion on five key areas:

  • Management of node-negative disease with tu­mours 1 cm or smaller in size
  • Management of HER2-positive EBC across the spectrum of the disease (that is, nodal and steroid hormone receptor status, tumour size)
  • Timing of trastuzumab therapy with chemotherapy for early-stage disease: concurrent or sequential
  • Treatment duration of trastuzumab for EBC
  • The role of non-anthracycline trastuzumab-based regimens

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DOI: http://dx.doi.org/10.3747/co.v17i4.700

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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)