From the Research
Introduction to Breast Cancer Treatment
Breast cancer is a heterogeneous group of diseases with distinct natural histories and varied responses to established therapies. Treatment approaches vary based on the presence or absence of certain receptors, including estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2).
Hormone Replacement Therapy in Breast Cancer
Hormone replacement therapy (HRT) is typically used to treat symptoms of menopause and is not recommended for patients with a history of breast cancer, especially those with hormone receptor-positive tumors. However, the question arises whether a patient with HER2-positive, ER-negative, and PR-negative breast cancer can be treated with HRT.
Considerations for HER2-Positive, ER-Negative, and PR-Negative Breast Cancer
According to 1, breast cancers that are HER2-positive and hormone receptor-negative are more aggressive and have a shorter survival rate. The use of trastuzumab, a humanized monoclonal antibody specific for HER-2/neu, has revolutionized the management of metastatic HER-2/neu-overexpressing breast cancers. However, this does not directly address the use of HRT in these patients.
Hormone Replacement Therapy and Breast Cancer Risk
Studies such as 2 and 3 discuss the treatment of hormone receptor-positive, HER2-negative breast cancers, which is not directly applicable to this patient population. However, they do highlight the importance of individualized treatment approaches based on tumor biology and patient preferences.
Treatment Approaches for HER2-Positive Breast Cancers
4 discusses the use of trastuzumab-based chemotherapy for early-stage HER2-positive breast cancers and suggests that a less-is-more approach may be appropriate for some patients. However, this does not address the use of HRT in these patients.
Pathologic Response and Hormone Receptor Status
5 compares the pathologic response of HER2-positive breast cancer treated with neoadjuvant chemotherapy and trastuzumab according to hormone receptor status. While this study provides insight into the treatment of HER2-positive breast cancers, it does not directly address the use of HRT.
Conclusion
Based on the available evidence, it is not recommended to use hormone replacement therapy in patients with HER2-positive, ER-negative, and PR-negative breast cancer. The primary concern is that HRT may stimulate the growth of any residual cancer cells, potentially leading to recurrence. Instead, treatment should focus on targeted therapies such as trastuzumab, as well as other systemic therapies as indicated by the patient's tumor biology and overall health.
Treatment Options
- Trastuzumab-based chemotherapy
- Other systemic therapies as indicated by tumor biology and patient preferences
- Close monitoring for signs of recurrence or disease progression
Caveats
- HRT is not recommended for patients with a history of breast cancer, especially those with hormone receptor-positive tumors.
- Treatment approaches should be individualized based on tumor biology, patient preferences, and overall health.
- Patients should be closely monitored for signs of recurrence or disease progression.