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HER2-positive advanced breast cancer treatment in 2020
Marcelle G Cesca1, Lucas Vian1, Sofia Cristóvão-Ferreira2
1Clinical Oncology Department, A.C. Camargo Cancer Center, Brazil.
Abstract:
HER2-positive breast cancer is an aggressive subtype identified in the 1980s. The development of therapies targeting the HER2 has improved outcomes. The current standard of care, established in 2012 is dual blockade with trastuzumab + pertuzumab as first-line followed by TDM-1 as second-line. Several suboptimal choices are available in third-line or more. In 2019 the presentation of several trials evaluating new drugs and regimens in third-line has re-opened questions about sequencing, treatment of triple positive disease and treatment choice after exposure to TDM-1. These include tucatinib, neratinib and trastuzumab-deruxtecan. Other agents - including other antibody drug conjugates and bispecific antibodies as well as combinations - will lead to further changes in coming years. Additionally, should the numerous putative biomarkers thus identified ever come into use at the clinic, choice of treatment and response evaluation may be substantially changed.
Insights
New HER2-targeted therapies are changing treatment sequencing for HER2-positive breast cancer. Research is exploring options beyond current standards, especially for third-line treatment and after TDM-1 exposure.
Area of Science:
- Oncology
- Pharmacology
Background:
- HER2-positive breast cancer is an aggressive subtype with improved outcomes due to targeted therapies.
- The current standard of care involves dual HER2 blockade (trastuzumab + pertuzumab) followed by TDM-1.
Purpose of the Study:
- To review recent advancements and ongoing questions in the treatment sequencing of HER2-positive breast cancer.
- To discuss emerging therapies and their potential impact on clinical practice.
Main Methods:
- Review of clinical trials and emerging data on novel HER2-targeted agents.
- Analysis of treatment sequencing challenges, including third-line options and post-TDM-1 strategies.
Main Results:
- Several new agents like tucatinib, neratinib, and trastuzumab-deruxtecan show promise in third-line settings.
- Ongoing research is evaluating antibody drug conjugates, bispecific antibodies, and combinations.
Conclusions:
- The landscape of HER2-positive breast cancer treatment is rapidly evolving with new therapeutic options.
- Future treatment decisions may be influenced by novel agents, combinations, and emerging biomarkers.
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