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[Locoregional breast radiotherapy and concurrent treatment with trastuzumab]
Julian Jacob1, Youlia M Kirova2
1Hôpital d'instruction des armées du Val-de-Grâce, service d'oncologie-radiothérapie, 74, boulevard de Port-Royal, 75230 Paris Cedex 05, France.
Abstract:
The overexpression of the Human Epidermal Growth Factor Receptor 2 (HER2) is observed in 15% of breast cancers and associated with poor prognosis in terms of overall survival. Trastuzumab is an anti-HER2 targeted therapy, leading to a specific inhibition of the molecular mechanisms triggered by this receptor. In an adjuvant setting, trastuzumab and radiotherapy have each proved their oncologic efficacy in the management of the breast tumours presenting this molecular profile. However, both treatments expose to an increased risk of toxicities, particularly cardiovascular ones. Moreover, the radiosensitizing effect of trastuzumab has been proved in vitro and in vivo. Hence, in clinical practice, the benefit/risk ratio of a concurrent treatment remains to be defined. This literature review has for purposes to describe the rationale making conceivable the administration of trastuzumab concurrently with locoregional breast radiotherapy, and to remind the results of the clinical studies having assessed this therapeutic association.
Insights
Concurrent trastuzumab and radiotherapy for HER2-positive breast cancer shows potential but requires careful benefit/risk assessment due to cardiovascular toxicity risks. Further clinical studies are needed to define optimal concurrent treatment strategies.
Area of Science:
- Oncology
- Pharmacology
- Radiotherapy
Context:
- HER2-overexpressing breast cancer (15% of cases) is linked to poor survival outcomes.
- Trastuzumab targets HER2, inhibiting downstream signaling pathways.
- Both trastuzumab and radiotherapy are effective in the adjuvant setting for HER2-positive breast cancer.
Purpose:
- To review the scientific rationale for combining trastuzumab with locoregional breast radiotherapy.
- To summarize clinical study findings on the concurrent administration of trastuzumab and radiotherapy.
- To evaluate the benefit/risk ratio of this combined therapeutic approach.
Summary:
- Trastuzumab, an anti-HER2 therapy, and radiotherapy are established treatments for HER2-positive breast cancer.
- Concurrent use is supported by in vitro and in vivo evidence of trastuzumab's radiosensitizing effect.
- Cardiovascular toxicities are a concern with both treatments, necessitating careful clinical evaluation.
Impact:
- Defines the clinical rationale for concurrent trastuzumab and radiotherapy in HER2-positive breast cancer.
- Highlights the need to balance oncologic benefits against potential toxicities, particularly cardiovascular risks.
- Informs clinical practice regarding the assessment of the benefit/risk ratio for this therapeutic combination.
