Post-Neoadjuvant Treatment in HER2-Positive Breast Cancer: Escalation and De-Escalation Strategies
Patients with high-risk non-metastatic breast cancer are recommended for chemotherapy, preferably in the neoadjuvant setting. Beyond advantages such as a better operability and an improved assessment of individual prognosis, the preoperative administration of systemic treatment offers the unique pos...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/12/3002 |
| _version_ | 1797489133251198976 |
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| author | Natalia Krawczyk Tanja Fehm Eugen Ruckhaeberle Laura Brus Valeria Kopperschmidt Achim Rody Lars Hanker Maggie Banys-Paluchowski |
| author_facet | Natalia Krawczyk Tanja Fehm Eugen Ruckhaeberle Laura Brus Valeria Kopperschmidt Achim Rody Lars Hanker Maggie Banys-Paluchowski |
| author_sort | Natalia Krawczyk |
| collection | DOAJ |
| description | Patients with high-risk non-metastatic breast cancer are recommended for chemotherapy, preferably in the neoadjuvant setting. Beyond advantages such as a better operability and an improved assessment of individual prognosis, the preoperative administration of systemic treatment offers the unique possibility of selecting postoperative therapies according to tumor response. In patients with HER2-positive disease, both the escalation of therapy in the case of high-risk features and the de-escalation in patients with a low tumor load are currently discussed. Patients with small node-negative tumors receive primary surgery and, upon confirmation of pathological T1 N0 status, de-escalated adjuvant therapy with paclitaxel and trastuzumab. For those with a large tumor and/or nodal involvement, neoadjuvant polychemotherapy with a dual antibody blockade is recommended. Patients with invasive residual disease benefit from switching postoperative therapy to the antibody-drug-conjugate trastuzumab emtansine (T-DM1). In this review, we discuss current evidence and controversies regarding post-neoadjuvant treatment strategies in HER2-positive breast cancer. |
| first_indexed | 2024-03-10T00:12:09Z |
| format | Article |
| id | doaj.art-7b05de73b1c347539870d41c3eb9f331 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T00:12:09Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-7b05de73b1c347539870d41c3eb9f3312023-11-23T15:57:48ZengMDPI AGCancers2072-66942022-06-011412300210.3390/cancers14123002Post-Neoadjuvant Treatment in HER2-Positive Breast Cancer: Escalation and De-Escalation StrategiesNatalia Krawczyk0Tanja Fehm1Eugen Ruckhaeberle2Laura Brus3Valeria Kopperschmidt4Achim Rody5Lars Hanker6Maggie Banys-Paluchowski7Department of Gynecology and Obstetrics, Henrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyDepartment of Gynecology and Obstetrics, Henrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyDepartment of Gynecology and Obstetrics, Henrich Heine University Düsseldorf, 40225 Düsseldorf, GermanyRegioklinikum Pinneberg, 25421 Pinneberg, GermanyRegioklinikum Pinneberg, 25421 Pinneberg, GermanyDepartment of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, 23562 Lübeck, GermanyDepartment of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, 23562 Lübeck, GermanyDepartment of Gynecology and Obstetrics, University Hospital Schleswig-Holstein Campus Lübeck, 23562 Lübeck, GermanyPatients with high-risk non-metastatic breast cancer are recommended for chemotherapy, preferably in the neoadjuvant setting. Beyond advantages such as a better operability and an improved assessment of individual prognosis, the preoperative administration of systemic treatment offers the unique possibility of selecting postoperative therapies according to tumor response. In patients with HER2-positive disease, both the escalation of therapy in the case of high-risk features and the de-escalation in patients with a low tumor load are currently discussed. Patients with small node-negative tumors receive primary surgery and, upon confirmation of pathological T1 N0 status, de-escalated adjuvant therapy with paclitaxel and trastuzumab. For those with a large tumor and/or nodal involvement, neoadjuvant polychemotherapy with a dual antibody blockade is recommended. Patients with invasive residual disease benefit from switching postoperative therapy to the antibody-drug-conjugate trastuzumab emtansine (T-DM1). In this review, we discuss current evidence and controversies regarding post-neoadjuvant treatment strategies in HER2-positive breast cancer.https://www.mdpi.com/2072-6694/14/12/3002breast cancerpost-neoadjuvant therapyHER2 positivetherapy responsesurvival |
| spellingShingle | Natalia Krawczyk Tanja Fehm Eugen Ruckhaeberle Laura Brus Valeria Kopperschmidt Achim Rody Lars Hanker Maggie Banys-Paluchowski Post-Neoadjuvant Treatment in HER2-Positive Breast Cancer: Escalation and De-Escalation Strategies Cancers breast cancer post-neoadjuvant therapy HER2 positive therapy response survival |
| title | Post-Neoadjuvant Treatment in HER2-Positive Breast Cancer: Escalation and De-Escalation Strategies |
| title_full | Post-Neoadjuvant Treatment in HER2-Positive Breast Cancer: Escalation and De-Escalation Strategies |
| title_fullStr | Post-Neoadjuvant Treatment in HER2-Positive Breast Cancer: Escalation and De-Escalation Strategies |
| title_full_unstemmed | Post-Neoadjuvant Treatment in HER2-Positive Breast Cancer: Escalation and De-Escalation Strategies |
| title_short | Post-Neoadjuvant Treatment in HER2-Positive Breast Cancer: Escalation and De-Escalation Strategies |
| title_sort | post neoadjuvant treatment in her2 positive breast cancer escalation and de escalation strategies |
| topic | breast cancer post-neoadjuvant therapy HER2 positive therapy response survival |
| url | https://www.mdpi.com/2072-6694/14/12/3002 |
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