title: [Management of metastatic HER2-positive breast cancer: present and future].
abstract: HER2-positive breast cancer accounts for 20 to 25% of breast cancers. The surexpression of this tyrosine-kinase receptor is often associated with a poor prognosis. However, the management and the outcome of these patients have changed these last ten years with trastuzumab. Despite the encouraging results obtained with this humanized monoclonal antibody directed against the HER2-receptor, used alone or in association with chemotherapy in metastatic patients, progression under trastuzumab are usually observed and resistances to this treatment are described. Thus, many other monoclonal antibodies and tyrosine-kinase inhibitors emerged. These therapeutics, used alone or in association with chemotherapy or trastuzumab have variable properties: anti-HER2 and anti-EGFR such as lapatinib, pertuzumab and neratinib; anti-EGFR such as erlotinib and gefitinib; antiangiogenesis (bevacizumab, pazopanib); anti-mTOR pathway (temsirolimus, everolimus) or inhibitor of HSP90 (tanespimycine). In this paper, we present an overview on validated targeted therapies and those which are currently under investigation and seem promising in first line or after progression under trastuzumab. Data regarding cardiotoxicity and the use of trastuzumab under particular clinical circumstances (brain metastases, pregnancy) are also reviewed.
authors.affiliation: Département d'oncologie médicale, centre de lutte contre le cancer Georges-François-Leclerc, 1, rue Professeur-Marion, 21000 Dijon, France.
authors.forename: S
authors.initials: S
authors.lastname: Guiu
authors.forename: B
authors.initials: B
authors.lastname: Coudert
authors.forename: L
authors.initials: L
authors.lastname: Favier
authors.forename: L
authors.initials: L
authors.lastname: Arnould
authors.forename: P
authors.initials: P
authors.lastname: Fumoleau
mesh_terms: D000077384:Anastrozole; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016227:Benzoquinones / Q000627:therapeutic use; D000068258:Bevacizumab; D001932:Brain Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000737:chemistry / Q000188:drug therapy* / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D006321:Heart / Q000187:drug effects; D006801:Humans; D047029:Lactams, Macrocyclic / Q000627:therapeutic use; D000077341:Lapatinib; D000077289:Letrozole; D009363:Neoplasm Proteins / Q000378:metabolism; D009570:Nitriles / Q000627:therapeutic use; D011799:Quinazolines / Q000627:therapeutic use; D011804:Quinolines / Q000627:therapeutic use; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism*; D000068878:Trastuzumab; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000077384:Anastrozole; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018931:Antineoplastic Agents, Hormonal; D016227:Benzoquinones; D000068258:Bevacizumab; D047029:Lactams, Macrocyclic; D000077341:Lapatinib; D000077289:Letrozole; D009363:Neoplasm Proteins; D009570:Nitriles; D011799:Quinazolines; D011804:Quinolines; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; D014230:Triazoles; C112765:tanespimycin; C487932:neratinib; C485206:pertuzumab