In patients with breast cancer, between 20% and 30% of patients will express human epidermal growth factor receptor-2 (HER-2) in their tumor tissue, i.e. HER-2 positive breast cancer. For these patients, targeted anti HER-2 therapy is an important treatment option.
What principles do doctors grasp when treating advanced breast cancer that is HER-2 positive? Come learn.
With what?
Physicians will first fully inform all patients with HER-2 positive recurrent or metastatic breast cancer of the benefits of and the need for timely anti HER-2 targeted therapy.
How does combination chemotherapy work?
- While trastuzumab (Trastuzumab ) is effective as a single agent for the treatment of HER-2 positive recurrent or metastatic breast cancer, additional clinical studies have shown that trastuzumab is synergistic with multiple chemotherapy agents and that combination chemotherapy is more effective.
- Trastuzumab in combination with paclitaxel may be preferred as a first-line regimen for recurrent or metastatic breast cancer that has failed anthracycline-based chemotherapy HER-2 positive. Trastuzumab in combination with paclitaxel (Paclitaxel) + carboplatin (Carboplatin) is more effective than trastuzumab in combination with paclitaxel; trastuzumab in combination with docetaxel (Docetaxel) + capecitabine (Capecitabine) is more effective than trastuzumab in combination with docetaxel.
- For HER-2 positive breast cancer that has failed paclitaxel chemotherapy, trastuzumab can also be combined with other chemotherapy drugs such as vinorelbine, capecitabine, and gemcitabine.
How do I choose a targeted agent?
- Adding pertuzumab (Pertuzumab) to trastuzumab in combination with a paclitaxel may further extend survival time. The National Comprehensive Cancer Network (NCCN) guidelines recommend that pertuzumab plus trastuzumab in combination with paclitaxel is the first-line regimen of choice. However, the first-line first choice for HER-2 positive metastatic breast cancer in China is still trastuzumab combined with paclitaxel (HT)-based chemotherapy, which can be combined with capecitabine (HTX) in addition to this.
- For those with HER-2 positive advanced breast cancer who develop brain metastases during treatment, physicians may consider continuing with the original targeted regimen if the extracranial lesions have not progressed and after effective local therapy.
What are the trade-offs for endocrine therapy?
For recurrent or metastatic breast cancer that is HER-2 positive and estrogen receptor (ER) and/or progesterone receptor (PR) positive, trastuzumab in combination with chemotherapy is generally preferred; some patients who are not candidates for chemotherapy or have slow progression may be considered for combination endocrine therapy if combined with anti HER-2 -targeted therapy in combination with aromatase The patient may be treated with an aromatase inhibitor on top of anti HER-2 targeted therapy.
For patients who have achieved disease stabilization with anti HER-2 targeted therapy in combination with chemotherapy, physicians may consider anti-HER-2 targeted therapy in combination with endocrine therapy after chemotherapy is stopped.
How long to use?
When using trastuzumab in combination with chemotherapy, effective chemotherapy generally lasts for at least 6 to 8 cycles, depending on the efficacy on the tumor and how well the patient tolerates the chemotherapy. After chemotherapy is stopped, physicians may consider trastuzumab maintenance therapy. If complete remission is obtained, the duration of anti HER2 targeted therapy should be weighed against the toxicity of the treatment, the economic burden, etc. It is also possible to suspend anti HER-2 therapy for several years after complete remission in some patients and resume the use of anti HER-2 therapy that had been used previously and benefited after the disease has progressed again. The first time the disease progresses again, the patient can resume the anti HER-2 drug therapy that was previously used and beneficial. (Contributed by Yang Yuqing, Department of Nail and Breast Vascular Surgery, Xijing Hospital, Air Force Military Medical University)