What are the treatment guidelines for Trastuzumab (Herceptin) therapy?

From the Guidelines

The most effective treatment strategy for patients with HER2-positive advanced breast cancer is to recommend HER2-targeted therapy, with trastuzumab, pertuzumab, and taxane for first-line treatment, and trastuzumab deruxtecan for second-line treatment, as outlined in the 2022 ASCO guideline update 1.

Key Recommendations

• HER2-targeted therapy is recommended for patients with HER2-positive advanced breast cancer, except for those with clinical congestive heart failure or significantly compromised left ventricular ejection fraction, who should be evaluated on a case-by-case basis.
• Trastuzumab, pertuzumab, and taxane for first-line treatment and trastuzumab deruxtecan for second-line treatment are recommended.
• In the third-line setting, clinicians should offer other HER2-targeted therapy combinations, including regimens with tucatinib, trastuzumab emtansine, trastuzumab deruxtecan (if not previously administered), neratinib, lapatinib, chemotherapy, margetuximab, hormonal therapy, and abemaciclib plus trastuzumab plus fulvestrant.

Treatment Considerations

• The patient and the clinician should discuss differences in treatment schedule, route, toxicities, etc. during the decision-making process.
• Optimal duration of chemotherapy is at least 4-6 months or until maximum response, depending on toxicity and in the absence of progression.
• HER2-targeted therapy can continue until time of progression or unacceptable toxicities.

Additional Guidance

• For patients with HER2-positive and estrogen receptor–positive or progesterone receptor–positive breast cancer, clinicians may recommend either standard first-line therapy or, for selected patients, endocrine therapy plus HER2-targeted therapy or endocrine therapy alone, as supported by the 2018 ASCO clinical practice guideline update 1.
• However, the 2022 guideline update 1 takes precedence, and its recommendations should be followed.

From the Research

Tratrelgy of Fellow Guidelines

There are no research papers to assist in answering this question as the provided studies do not mention "Tratrelgy of fellow guidelines".

• The studies provided are related to:
  • Ultrasonography for the diagnosis and management of thyroid cancer 2
  • Sepsis and immunosuppression 3
  • Global prevalence of child and adolescent overweight and obesity 4
  • Oncogenic RAS and non-canonical autophagy 5
• None of these studies mention "Tratrelgy of fellow guidelines", therefore, there is no relevant information to provide.