Advances in First-Line Treatment for Patients with HER-2+ Metastatic Breast Cancer

Abstract

Abstract Learning Objectives: After completing this course, the reader will be able to: Discuss the optimal strategies to treat HER-2+ metastatic breast cancer patients in the first-line setting and after recurrence with adjuvant trastuzumab.Identify the current first-line therapeutic options for HER-2+ metastatic breast cancer, including HER-2/hormone receptor copositive tumors.Discuss the most important advances for HER-2+ metastatic breast cancer and the potential of novel anti-HER-2 therapies. CME This article is available for continuing medical education credit at CME.TheOncologist.com Background. The prognosis for breast cancer patients overexpressing human epidermal growth factor receptor (HER)-2 has changed with anti–HER-2–targeted therapy. Although anti–HER-2 therapy with trastuzumab and chemotherapy is the standard first-line treatment, the best therapeutic regimen has yet to be defined, and new strategies are evolving. Methods. A literature review of well-established and recently published trials, reviews, and ongoing clinical trials addressing first-line treatment for HER-2+ metastatic breast cancer patients was performed. Results. Taxanes are the agents most commonly used in combination with trastuzumab, but other chemotherapy drugs, such as anthracyclines, vinorelbine, and gemcitabine and triple-combination therapies including platinum compounds, capecitabine, and taxanes have been studied. The combination of aromatase inhibitors with anti–HER-2 therapies is a new therapeutic option for some patients who coexpress HER-2 and hormone receptors, although its activity observed in randomized clinical trials seems to be inferior to that of chemotherapy plus anti–HER-2 therapies. In addition, new anti–HER-2 therapies have shown activity in HER-2+ tumors, both alone and in combination with trastuzumab. Conclusions. Trastuzumab plus chemotherapy is the current standard of care for the upfront treatment of HER-2+ breast cancer patients, though other anti–HER-2–targeting agents may appear as new standards in the upcoming years.