This shows a novel shift in the management of preventing recurrence and not just treating intial cases or recurrences. The suggestion is to use Herceptin in the future to prevent many Her2 positive cancers that recur in the 5-6 year range.
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The information provided from the study of the patterns of recurrence in early breast cancer would benefit to the patients in different ways. In this regard, our results could generate several hypotheses that, if confirmed in prospective randomized trials, would have noteworthy practical value. First of all, the surveillance after initial treatment could fit to the expected recurrence pattern depending on each intrinsic subtype. But more importantly, the adjuvant treatment could be tailored more accurately according to each intrinsic subtype.
Patients with tumors with high proliferation rate such HER2-enriched or basal-like would benefit from more aggressive chemotherapy schedules (e.g. dose-dense). Such type of chemotherapy could avoid some of the recurrences appeared during the first peak. Also in these cases with high expression of proliferation pathways, it could be especially useful the treatment with novel inhibitors of cell cycle (e.g. palbociclib).
In addition, those other patients with Luminal-HER2 subtype could benefit from a second treatment with trastuzumab in order to decrease the second peak of recurrences.
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