title: Anti-HER2 Therapy Beyond Second-Line for HER2-Positive Metastatic Breast Cancer: A Short Review and Recommendations for Several Clinical Scenarios from a Spanish Expert Panel.
abstract: BACKGROUND
  The aim of this project was to provide an expert opinion regarding anti-human epidermal growth factor receptor 2 (HER2) therapy beyond second-line treatment of metastatic breast cancer (mBC).
  
  
  METHODS
  A group of experts discussed specific issues concerning anti-HER2 therapy in late-line settings in mBC.
  
  
  RESULTS
  Trastuzumab emtansine (T-DM1) or dual HER2 blockade appeared to be good options for HER2-positive mBC after ≥ 2 HER2-targeted therapies. Once an objective response has been achieved with anti-HER2-containing therapy, the anti-HER2 agent can be continued until progression of the disease, unacceptable toxicity or patient decision. mBC treated with ≥ 3 consecutive lines of anti-HER therapy, ≥ 1 being a dual HER2 blockade and with early progression of disease during a fourth or later-line treatment, are clinically resistant to anti-HER therapy. For progression of metastasis in the brain after anti-HER2 therapy, lapatinib and chemotherapy appear to be a good alternative after best local treatment.
  
  
  CONCLUSIONS
  Further clinical trials are needed to provide valuable knowledge about the best treatment options in the later settings of mBC.
authors.affiliation: Medical Oncology Department, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Noelia
authors.initials: N
authors.lastname: Martínez-Jañez
authors.affiliation: Medical Oncology Department, Hospital Virgen de la Salud, Toledo, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Chacón
authors.affiliation: Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: de Juan
authors.affiliation: Medical Oncology Department, Hospital Virgen de la Macarena, Sevilla, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Cruz-Merino
authors.affiliation: Instituto Catalán de Oncología, Hospital Universitario Doctor Josep Trueta, Gerona, Spain.
authors.forename: Sònia
authors.initials: S
authors.lastname: Del Barco
authors.affiliation: Hospital Xeral Cies de Vigo, Pontevedra, Spain.
authors.forename: Isaura
authors.initials: I
authors.lastname: Fernández
authors.affiliation: Hospital de Avilés, Asturias, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: García-Teijido
authors.affiliation: Hospital Clínico de Salamanca, Salamanca, Spain.
authors.forename: Amalia
authors.initials: A
authors.lastname: Gómez-Bernal
authors.affiliation: Onkologikoa, San Sebastián, Spain.
authors.forename: Arrate
authors.initials: A
authors.lastname: Plazaola
authors.affiliation: Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Ponce
authors.affiliation: Hospital del Mar, Barcelona, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Servitja
authors.affiliation: Hospital la Paz, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Zamora
keywords: Anti-HER2; Clinical practice; Metastatic breast cancer