TY - JOUR
T1 - Post-Neoadjuvant Treatment in HER2-Positive Breast Cancer
T2 - Escalation and De-Escalation Strategies
AU - Krawczyk, Natalia
AU - Fehm, Tanja
AU - Ruckhaeberle, Eugen
AU - Brus, Laura
AU - Kopperschmidt, Valeria
AU - Rody, Achim
AU - Hanker, Lars
AU - Banys-Paluchowski, Maggie
N1 - Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2022/6/18
Y1 - 2022/6/18
N2 - 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 antibodydrug-conjugate trastuzumab emtansine (T-DM1). In this review, we discuss current evidence and controversies regarding post-neoadjuvant treatment strategies in HER2-positive breast cancer.
AB - 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 antibodydrug-conjugate trastuzumab emtansine (T-DM1). In this review, we discuss current evidence and controversies regarding post-neoadjuvant treatment strategies in HER2-positive breast cancer.
UR - http://www.scopus.com/inward/record.url?scp=85132012197&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/05e43492-d126-38ad-96ed-3228be382c6b/
U2 - 10.3390/cancers14123002
DO - 10.3390/cancers14123002
M3 - Scientific review articles
C2 - 35740667
AN - SCOPUS:85132012197
SN - 2072-6694
VL - 14
JO - Cancers
JF - Cancers
IS - 12
M1 - 3002
ER -