Abstract
Despite relevant medical advancements, metastatic breast cancer remains an uncurable disease. HER2 signaling conditions tumor behavior and treatment strategies of HER2 expressing breast cancer. Cancer treatment guidelines uniformly identify dual blockade with pertuzumab and trastuzumab plus a taxane as best first line and trastuzumab emtansine as preferred second line choice. However, there is no prospectively designed available study focusing on the sequence and outcomes of patients treated with T-DM1 following the triplet. In the following report, data concerning a wide series of patients treated in a real-life setting are presented. Results obtained in terms of response and median progression free survival suggests a significant role for T-DM1 in disease control of metastatic HER2 expressing breast cancer.
Highlights
From 80s, Human Epidermal Growth Factor Receptor 2 (HER2) signaling was increasingly recognized as pivotal in tumor growth of HER2 expressing breast cancer
Results obtained in terms of response and median progression free survival suggests a significant role for adotrastuzumab emtansine (T-DM1) in disease control of metastatic HER2 expressing breast cancer
Current available guidelines in metastatic HER2 positive breast cancer designs a sequence of treatment with first-line double blockade with trastuzumab plus pertuzumab and a taxane according to Cleopatra trial results [1] and secondline treatment with trastuzumab emtansine (T-DM1) enforced by Emilia trial results [2] and, lapatinib plus capecitabine [3]
Summary
From 80s, Human Epidermal Growth Factor Receptor 2 (HER2) signaling was increasingly recognized as pivotal in tumor growth of HER2 expressing breast cancer. In 2019, the KATHERINE trial showed a significant benefit of adjuvant T-DM1 in HER2-positive patients treated with neoadjuvant treatment and not achieving a pathologic complete response [7]. These patients showed with adjuvant T-DM1 a risk of recurrence 50% lower than with trastuzumab alone. Such results induced FDA on May 3, 2019 to approve T-DM1 for the adjuvant treatment of patients with HER2-positive early breast cancer treated with neoadjuvant taxane and trastuzumab-based treatment and having residual invasive disease in the breast or axilla at surgery [8]. In Italy, T-DM1 is authorized in this setting on an individual basis in the context of a compassionate use
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