Finding the Sweet Spot in the Management of Early HER2+ Breast Cancer

摘要

The discovery of the HER2 alteration1,2 and subsequent development of the human epidermal growth factor receptor 2 (HER2)–targeted antibody, trastuzumab,3–7 is one of the most dramatic success stories in the history of oncology. After trastuzumab, came the development of a variety of new HER2-directed drugs including monoclonal antibodies, small-molecule tyrosine kinase inhibitors, and antibody drug conjugates. The approval of three of these newer agents8–11 in the (neo)adjuvant setting provides patients who are at high risk of recurrence a better chance of remaining disease free. That said, the availability of multiple targeted therapies for early HER2-positive breast cancer has made treatment decisions tremendously complex in recent years. Properly judging how much therapy to give a particular patient is a tricky endeavor that must take into account not only data from dozens of clinical trials but also patient-specific factors including disease risk, comorbidities, lifestyle considerations, and cost. Navigating the myriad options is not a job for the faint of heart.