Updated Austrian treatment algorithm in HER2+ metastatic breast cancer.

Rupert Bartsch,Edgar Petru,Daniel Egle,Andreas Petzer,Marija Balic,Gabriel Rinnerthaler,Christian Singer,Simon Peter Gampenrieder,Thamer Sliwa,Ursula Pluschnig

doi:10.1007/s00508-021-01987-9

Abstract

A group of Austrian breast cancer specialists met in December 2020 to establish a comprehensive clinical benefit-risk profile of available HER2-targeted therapies based on recent data and to develop an updated treatment algorithm by consensus over several months in 2021. A total of four scenarios were developed in which treatment strategies appropriate for specific patient profiles were evaluated. Consensus was established by detailed discussions of each scenario and by reaching full consensus.Supplementary InformationThe online version of this article (10.1007/s00508-021-01987-9) contains supplementary material, which is available to authorized users.

Highlights

HER2-positive breast cancer, characterized by the overexpression of the HER2 protein and/or amplification of the HER2/neu gene has experienced a significant growth in treatment options over the last two decades
The tyrosine kinase inhibitors (TKIs) lapatinib and neratinib are available for the treatment of HER2-positive breast cancer (Fig. 6; [10,11,12,13])
Trastuzumab, pertuzumab, and T-DM1 [9] are routinely used in theadjuvant and postneoadjuvant settings, which may result in limited treatment options in cases of disease recurrence; additional options are required in patients progressing on standard therapy

Summary

Introduction

HER2-positive breast cancer, characterized by the overexpression of the HER2 protein and/or amplification of the HER2/neu gene has experienced a significant growth in treatment options over the last two decades. The introduction of the monoclonal antibody trastuzumab as the first HER2-specific targeted therapy led to tremendous improvement in recurrencefree survival and overall survival (OS) in early breast cancer [2] and progression-free survival (PFS) and OS in metastatic disease [3]. For the TKI tucatinib, conditional approval was granted on 12 February 2021 [17]. Both compounds have been evaluated in several clinical trials in recent years [18,19,20,21,22,23,24,25], necessitating the development of revised treatment recommendations

Results

Discussion

Conclusion