HER2-positive metastatic breast cancer: a changing scenario.
Adjuvant trastuzumab (AT) dramatically improved HER2-positive breast cancer prognosis. Relapsed disease after AT has different patterns and information is available from observational studies. In this Review Chemotherapy regimens combined to anti-HER2 blockade are discussed, focusing in particular the role of anthracyclines, taxanes and capecitabine. The use of trastuzumab beyond progression and the role of other anti-HER2 agents like lapatinib, pertuzumab and T-DM1 are explored, as also dual blockade and in trastuzumab resistant Patients. Metastatic "de novo" HER2 Luminal (co-expression of HER2 and hormone receptors) Patients are eligible for anastrozole and trastuzumab but if pretreated with trastuzumab they are also eligible for lapatinib and letrozole. In any case endocrine treatment plays a complementary role to chemotherapy which remains pivotal. The last topic explored is treatment options for patients with brain metastases where both trastuzumab given concurrent with radiotherapy or lapatinib and capecitabine appear as potentially active.
Medical Oncology, Department of Medical Sciences, University of Trieste, Italy. Electronic address: gmustacchi@units.it.
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G
Mustacchi
Department of Oncology, New Hospital of Prato, Italy.
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L
Biganzoli
Department of Oncology, San Martino Hospital and National Institute for Cancer Research, Genova, Italy.
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P
Pronzato
Department of Oncology, Institute for Cancer Research and Treatment, Candiolo (TO), Italy.
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F
Montemurro
Department of Oncology, Multimedica, Sesto San Giovanni (MI), Italy.
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M
Dambrosio
Department of Oncology, S. Eugenio Hospital, Roma, Italy.
M
M
Minelli
Department of Oncology, Multimedica, Castellanza (VA), Italy.
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L
Molteni
Department of Oncology, Civil Hospital, Guastalla (MN), Italy.
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L
Scaltriti
D000080044:Ado-Trastuzumab Emtansine; D018943:Anthracyclines / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001921:Brain / Q000187:drug effects / Q000473:pathology; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary*; D001940:Breast / Q000187:drug effects / Q000473:pathology; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D000069287:Capecitabine / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000379:methods; D005260:Female; D006801:Humans; D000077341:Lapatinib; D008453:Maytansine / Q000031:analogs & derivatives / Q000627:therapeutic use; D009362:Neoplasm Metastasis / Q000188:drug therapy / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology; D011799:Quinazolines / Q000627:therapeutic use; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis*; D043823:Taxoids / Q000627:therapeutic use; D000068878:Trastuzumab / Q000627:therapeutic use
D000080044:Ado-Trastuzumab Emtansine; D018943:Anthracyclines; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000069287:Capecitabine; D000077341:Lapatinib; D008453:Maytansine; D011799:Quinazolines; D018719:Erb-b2 Receptor Tyrosine Kinases; D043823:Taxoids; D000068878:Trastuzumab; C485206:pertuzumab
Breast cancer; HER2; Metastatic disease; Trastuzumab