How is stage I, IIA, IIB, or IIIA (T3N1M0) HER2/neu-positive breast cancer treated?

Updated: Apr 23, 2020
  • Author: Joseph A Sparano, MD; Chief Editor: John V Kiluk, MD, FACS  more...
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Anti-HER2/neu–directed therapy (eg, trastuzumab, neratinib) is indicated for use in combination with chemotherapy in patients with HER2/neu-positive disease. HER2/neu overexpression occurs in about 15-20% of cases of localized breast cancer, is associated with a higher risk of recurrence, and identifies patients who benefit from adjuvant anti-HER2/neu directed therapy.

Treatment considerations regarding trastuzumab and neratinib include the following:

  • Trastuzumab and neratinib are anti-HER2/neu–directed therapies that have been shown to reduce the risk of recurrence.

  • In studies of trastuzumab, patients were randomly assigned to receive chemotherapy alone or in combination with trastuzumab. [12]

  • Overlapping trastuzumab therapy with taxane therapy has been suggested to be more effective than a strategy of completing all chemotherapy first and then administering trastuzumab.

  • Pertuzumab is indicated for use in combination with trastuzumab and chemotherapy for the adjuvant treatment of patients with HER2-positive early breast cancer at high risk of recurrence.

  • Trastuzumab cannot be given concurrently with anthracyclines, because of the high risk of cardiac toxicity.

  • The FDA has approved four biosimilars of trastuzumab (Herzuma, Ogivri, Ontruzant, Trazimera), to treat HER2-overexpressed breast cancer. The availability of biosimilars will provide additional treatment options for patients in the adjuvant setting.

  • Neratinib is indicated for extended (ie, 1 year) adjuvant treatment of early-stage HER2-overexpressed/amplified breast cancer, to follow adjuvant trastuzumab-based therapy. [13]

  • Diarrhea is a dose-limiting adverse effect of neratinib.

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