Management of HER2-Positive Early Breast Cancer in Italy: A Maze Presenting Opportunities and Challenges
The management of human epidermal growth factor receptor 2 (HER2)-positive early-stage breast cancer (BC) has changed in recent years thanks to the introduction of anti-HER2 agents in clinical practice as standard of care in the neoadjuvant setting. In this scenario, we probed the issue of which HER...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.871160/full |
| _version_ | 1818208996581965824 |
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| author | Luigia Stefania Stucci Marco Pisino Claudia D’Addario Teresa Grassi Angela Toss |
| author_facet | Luigia Stefania Stucci Marco Pisino Claudia D’Addario Teresa Grassi Angela Toss |
| author_sort | Luigia Stefania Stucci |
| collection | DOAJ |
| description | The management of human epidermal growth factor receptor 2 (HER2)-positive early-stage breast cancer (BC) has changed in recent years thanks to the introduction of anti-HER2 agents in clinical practice as standard of care in the neoadjuvant setting. In this scenario, we probed the issue of which HER2-positive BC patients are eligible for neoadjuvant or for adjuvant treatment, since these therapeutic strategies seem to be mutually exclusive in clinical practice according to an Italian drug surveillance system. We reviewed both alternatives to establish which is more suitable, considering the anti-HER2 drugs available in Italy. Randomized clinical trials demonstrated a similar clinical benefit for chemotherapy administered as neoadjuvant therapy or adjuvant therapy. A meta-analysis, including 11,955 patients treated with neoadjuvant therapy, demonstrated an improvement in event-free survival (EFS) and overall survival (OS). Moreover, the recent APHINITY trial, analyzed at 6 years follow-up, demonstrated the superiority of the combination pertuzumab–trastuzumab versus trastuzumab–placebo in previously untreated patients. A greater benefit was found in patients with positive lymph nodes treated in the adjuvant setting. Our analysis underlines the need for a therapeutic decision-making algorithm, which is still unavailable, to support clinicians in identifying patients suitable for neoadjuvant or adjuvant therapy. Further prospective clinical trials should be performed in collaboration with other Italian Breast Cancer Centers to establish the best strategy to be adopted in early HER2+ BC. |
| first_indexed | 2024-12-12T04:53:41Z |
| format | Article |
| id | doaj.art-ec9cbf1375b74ef58c1622ea7354e72c |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-12T04:53:41Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-ec9cbf1375b74ef58c1622ea7354e72c2022-12-22T00:37:24ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-05-011210.3389/fonc.2022.871160871160Management of HER2-Positive Early Breast Cancer in Italy: A Maze Presenting Opportunities and ChallengesLuigia Stefania Stucci0Marco Pisino1Claudia D’Addario2Teresa Grassi3Angela Toss4Department of Biomedical Sciences and Human Oncology, Azienda Ospedaliero-Universitaria (A.O.U.), Consorziale Policlinico di Bari, Bari, ItalyDepartment of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, ItalyDepartment of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, ItalyDepartment of Biomedical Sciences and Human Oncology, Azienda Ospedaliero-Universitaria (A.O.U.), Consorziale Policlinico di Bari, Bari, ItalyDepartment of Oncology and Haematology, Genetic Oncology Unit, University Hospital of Modena, Modena, ItalyThe management of human epidermal growth factor receptor 2 (HER2)-positive early-stage breast cancer (BC) has changed in recent years thanks to the introduction of anti-HER2 agents in clinical practice as standard of care in the neoadjuvant setting. In this scenario, we probed the issue of which HER2-positive BC patients are eligible for neoadjuvant or for adjuvant treatment, since these therapeutic strategies seem to be mutually exclusive in clinical practice according to an Italian drug surveillance system. We reviewed both alternatives to establish which is more suitable, considering the anti-HER2 drugs available in Italy. Randomized clinical trials demonstrated a similar clinical benefit for chemotherapy administered as neoadjuvant therapy or adjuvant therapy. A meta-analysis, including 11,955 patients treated with neoadjuvant therapy, demonstrated an improvement in event-free survival (EFS) and overall survival (OS). Moreover, the recent APHINITY trial, analyzed at 6 years follow-up, demonstrated the superiority of the combination pertuzumab–trastuzumab versus trastuzumab–placebo in previously untreated patients. A greater benefit was found in patients with positive lymph nodes treated in the adjuvant setting. Our analysis underlines the need for a therapeutic decision-making algorithm, which is still unavailable, to support clinicians in identifying patients suitable for neoadjuvant or adjuvant therapy. Further prospective clinical trials should be performed in collaboration with other Italian Breast Cancer Centers to establish the best strategy to be adopted in early HER2+ BC.https://www.frontiersin.org/articles/10.3389/fonc.2022.871160/fullHER2+ breast cancerearly stagetreatmentItaly managementclinical practice |
| spellingShingle | Luigia Stefania Stucci Marco Pisino Claudia D’Addario Teresa Grassi Angela Toss Management of HER2-Positive Early Breast Cancer in Italy: A Maze Presenting Opportunities and Challenges Frontiers in Oncology HER2+ breast cancer early stage treatment Italy management clinical practice |
| title | Management of HER2-Positive Early Breast Cancer in Italy: A Maze Presenting Opportunities and Challenges |
| title_full | Management of HER2-Positive Early Breast Cancer in Italy: A Maze Presenting Opportunities and Challenges |
| title_fullStr | Management of HER2-Positive Early Breast Cancer in Italy: A Maze Presenting Opportunities and Challenges |
| title_full_unstemmed | Management of HER2-Positive Early Breast Cancer in Italy: A Maze Presenting Opportunities and Challenges |
| title_short | Management of HER2-Positive Early Breast Cancer in Italy: A Maze Presenting Opportunities and Challenges |
| title_sort | management of her2 positive early breast cancer in italy a maze presenting opportunities and challenges |
| topic | HER2+ breast cancer early stage treatment Italy management clinical practice |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.871160/full |
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