From the Guidelines
The best treatment for HER2-positive breast cancer typically involves targeted therapy with trastuzumab combined with chemotherapy, and for high-risk patients, adding pertuzumab and using more intensive chemotherapy may be recommended, as supported by the most recent guidelines 1. When considering treatment options, it's essential to evaluate the disease stage, prior therapies, and patient factors. For early-stage disease, a standard regimen includes 12 weeks of weekly paclitaxel with concurrent trastuzumab, followed by trastuzumab alone to complete one year of treatment.
- Key considerations include:
- Disease stage: early-stage or metastatic
- Prior therapies: previous use of HER2-targeted therapies or chemotherapy
- Patient factors: cardiac function, hormone receptor status, and overall health For metastatic disease, trastuzumab with pertuzumab and a taxane is the preferred first-line approach, with T-DM1 often used in second-line, as recommended by the American Society of Clinical Oncology (ASCO) guideline update 1. Regular cardiac monitoring is essential during treatment as HER2-targeted therapies can cause heart dysfunction.
- Additional treatment options may include:
- Hormonal therapy for patients with hormone receptor-positive disease
- Extended adjuvant therapy with neratinib for selected patients
- Other HER2-targeted therapy combinations, such as trastuzumab deruxtecan, tucatinib, or lapatinib, for patients who have progressed on previous therapies, as discussed in the ASCO guideline update 1.
From the FDA Drug Label
PERJETA is a HER2/neu receptor antagonist indicated for: Use in combination with trastuzumab and docetaxel for treatment of patients with HER2-positive metastatic breast cancer (MBC) who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease. Ogivri is indicated in adults for adjuvant treatment of HER2 overexpressing node positive or node negative (ER/PR negative or with one high risk feature) breast cancer as part of a treatment regimen consisting of doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel NERLYNX as a single agent is indicated for the extended adjuvant treatment of adult patients with early-stage human epidermal growth factor receptor 2 (HER2)-positive breast cancer, to follow adjuvant trastuzumab based therapy
The best treatment for HER2 positive breast cancer is a combination of therapies, including:
- Trastuzumab 2
- Pertuzumab 3
- Chemotherapy, such as docetaxel For extended adjuvant treatment, neratinib 4 may be used as a single agent after adjuvant trastuzumab-based therapy. For advanced or metastatic breast cancer, neratinib 4 in combination with capecitabine may be used for patients who have received two or more prior anti-HER2 based regimens.
From the Research
Treatment Options for HER2-Positive Breast Cancer
The treatment for HER2-positive breast cancer typically involves a combination of therapies, including:
- Trastuzumab, a monoclonal antibody that targets the HER2 protein 5, 6, 7, 8
- Pertuzumab, another monoclonal antibody that targets the HER2 protein 5, 6, 8
- Taxanes, such as paclitaxel or docetaxel, which are chemotherapeutic agents 5, 6, 9, 8
- Capecitabine, an oral chemotherapeutic agent 9, 7
- Tucatinib, a highly selective inhibitor of the HER2 tyrosine kinase 7
First-Line Treatment
The current standard first-line therapy for patients with HER2-positive metastatic breast cancer is a taxane combined with trastuzumab and pertuzumab 5. Studies have shown that this combination is effective in improving overall survival and progression-free survival 6, 8.
Second-Line and Subsequent Treatments
For patients who have progressed on first-line therapy, trastuzumab deruxtecan may be used preferentially in the second line, with the exception of patients with CNS involvement, where the tucatinib, capecitabine, and trastuzumab regimen may be considered 5. In the third line setting, the tucatinib regimen is preferred, given its survival benefits in patients with and without CNS metastases 5, 7. For subsequent lines of treatment, options include margetuximab in combination with chemotherapy, neratinib + capecitabine, or trastuzumab + chemotherapy 5.
Efficacy and Safety
Studies have demonstrated the efficacy and safety of these treatment combinations, with overall response rates ranging from 81.1% to 86.8% 6, 9, 8. Common adverse events include diarrhea, palmar-plantar erythrodysesthesia syndrome, nausea, fatigue, and vomiting 7.