important reading--in an editorial about an article

[Lani]

describing different subtypes of her2+ breast cancer with different prognoses the following stands:
OPEN ACCESS: EDITORIAL: HER2 Signatures in Breast Cancer: Ready to Go to Print?
[Journal of Clinical Oncology]
After analyzing the findings from Staaf et al, the question that we need to address is whether we are ready to use the HDPP gene signature in the management of HER2-positive breast cancer? The answer is clearly no, at least for now. As with all previous published breast cancer signatures comparing molecular classification with clinical outcome, their conclusions are based on retrospective data, somewhat limiting their clinical value. A greater limitation of this work is that the analyzed data sets were from patients who had not received trastuzumab therapy, the standard of care in patients with early HER2-positive breast cancer and that has markedly changed the outlook of HER2-positive disease. Although they looked at a small trastuzumab neoadjuvant study, the sample size was too small to draw any conclusion. Therefore, we do not know whether the results of this signature would apply in patients treated with trastuzumab, because prognostic signatures may not necessarily be predictive of response to therapy, as suggested in the current data set in a subgroup with favorable prognosis that displayed high PI3K activation, an indicator of trastuzumab resistance.

Personalized medicine is about better therapies for the right patient. In the HER2 field, we have made remarkable strides in the introduction of novel therapies. To fulfill the promise of personalized care, it may now be the time to work on the other half of the equation, an improved understanding of the behavior of each individual HER2-positive tumor. The identification of a subgroup of HER2 tumors with an improved prognosis could lead, for example, to the use of less aggressive chemotherapy or even to the administration of anti-HER therapies without chemotherapy or in combination with hormonal therapy. This work by Staaf et al is an excellent starting point to help decipher the prognosis of different subsets of HER2-positive tumors. In conclusion, an HER2 signature may not be yet ready to be implemented in our daily clinical practice, but it will likely become an important tool in the care of patients with HER2-positive breast cancer. So, the HER2 signature may not be ready to go to print, but it is almost in press.