10 fast facts about HER-2–positive breast cancer
Increased knowledge about breast cancer subtypes has led to the development of highly targeted treatments for these subtypes. Although breast cancers with an overexpression of HER-2 may grow more quickly, recent studies have found that they respond favorably to some of the newer agents.
In particular, newer drugs such as trastuzumab and ado-trastuzumab emtansine have yielded impressive results on patients with HER-2–positive
breast cancer.
However, these newer agents have not yet become cost effective: in 2013,
HemOnc Today reported that ado-trastuzumab, a front-runner in the treatment of HER-2–positive disease, cost about $9,800 per month. Given the median PFS of 9.6 months associated with the drug, a complete course of treatment would cost approximately $94,080.
Yet if these newer, targeted agents prove to be the “game changers” they show signs of becoming, this may be well worth the cost.
HemOnc Today presents 10 “fast facts” clinicians should consider with regard to the identification, treatment and management of patients with
HER-2–positive breast cancer.
1. Adding everolimus to a regimen of trastuzumab and vinorelbine may improve PFS.
According to a recent randomized, double-blind, phase 3 study, the addition of everolimus to a combination of trastuzumab and
vinorelbine yielded a median PFS of seven months in women with HER-2–positive breast cancer.
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2. Recent ASCO guidelines recommend chemotherapy, trastuzumab and pertuzumab as first-line systemic therapy for advanced HER-2–positive breast cancer.
In 2014, The American Society of Clinical Oncologists (ASCO) released two clinical practice guidelines for treating patients with advanced HER-2–positive breast cancer. In the first guideline, ASCO advised a first-line treatment of chemotherapy,
trastuzumab and pertuzumab for the systemic treatment of patients with inoperable, locally advanced and metastatic HER-2–positive breast cancer.
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3. For brain metastases linked to advanced HER-2–positive disease with a good survival prognosis, ASCO recommends surgery and/or radiotherapy.
ASCO’s second guideline pertained to brain metastases, which occur in 30 to 40% of patients with HER-2–positive breast cancer. For patients with a poor prognosis for survival, ASCO advised options such as surgery,
whole brain radiation therapy and systemic therapies.
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4. In patients with stage I HER-2-positive breast cancer, adjuvant paclitaxel and trastuzumab may extend disease-free survival.
A study presented at the San Antonio Breast Cancer Symposium found that women with stage I HER-2–positive disease had increased disease-free survival with a regimen of adjuvant
paclitaxel and trastuzumab. The researchers noted, however, that patients with T1a tumors may not require trastuzumab-based chemotherapy.
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5. HER-2–positive patients who showed progression after treatment with trastuzumab and lapatinib had improved PFS when treated with ado-trastuzumab emtansine vs. other medications.
According to recent findings from the phase 3 TH3RESA trial, patients with HER-2–positive breast cancer that continued to advance after treatment with trastuzumab and
lapatinib had significantly longer median PFS with a regimen of ado-trastuzumab emtansine, vs. physician’s choice of treatment.
10 fast facts about HER-2–positive breast cancer
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