How Early-Stage HER2-Positive Breast Cancer Treatment Has Evolved - All Good Tutorials (2023)

How Early-Stage HER2-Positive Breast Cancer Treatment Has Evolved - All Good Tutorials (1)

  • The first focused therapy for human epidermal progress issue receptor 2 (HER2)-positive breast most cancers, trastuzumab (Herceptin), was permitted in 1998.
  • Since then, researchers have continued to seek out new and higher methods to mix trastuzumab with different therapies.
  • These discoveries have considerably improved the as soon as poor survival price, serving to individuals with early-stage HER2-positive breast most cancers dwell longer, more healthy lives.

How Early-Stage HER2-Positive Breast Cancer Treatment Has Evolved - All Good Tutorials (2)

As docs and researchers be taught extra about breast most cancers, they proceed to develop new methods to deal with it. The therapy of HER2-positive breast most cancers has considerably improved for the reason that Nineties, with new advances made almost yearly.

Before the U.S. Food and Drug Administration (FDA) permitted trastuzumab (Herceptin) in 1998, many individuals with HER2-positive breast most cancers had a poor prognosis (outlook). Now, new therapies assist many individuals attain remission and dwell longer, more healthy lives. These remedies have turn out to be more practical and handy in addition to safer lately.

In this text, we’ll talk about the invention of the HER2 protein and the way the event of focused therapies revolutionized remedies for early-stage HER2-positive breast most cancers.

History of HER2 in Breast Cancer

In 1987, Dennis Slamon, M.D., and his colleagues reported that prime ranges of the HER2 protein had been seen in round 30 percent of breast cancers. (A 2020 study locations this determine at 20 %.) HER2 sends alerts to cells, telling them to develop and divide. In HER2-positive breast most cancers, tumor cells have an excessive amount of of this protein, so that they obtain too many alerts. As a end result, the cells develop and divide uncontrollably, making a fast-growing tumor.

(Video) HER2 Positive Breast Cancer: Everything You Must Know

Researchers discovered that HER2-positive breast most cancers was extra more likely to recur (return after therapy) and metastasize (unfold to different components of the physique). It was additionally related to increased dying charges. As a end result, researchers concluded that the HER2 protein was essential in breast most cancers improvement and development.

Researchers started engaged on new remedies to dam HER2 and cease breast most cancers cells from rising and dividing.

1992-2006: Development and Approval of Trastuzumab

In 1992, the antibody trastuzumab was developed. Antibodies are proteins made by the immune system. In this case, trastuzumab is a laboratory-engineered antibody, also referred to as a monoclonal antibody. This was the primary focused therapy for HER2-positive most cancers. Trastuzumab attaches to the HER2 protein, stopping it from sending alerts to cells.

How Early-Stage HER2-Positive Breast Cancer Treatment Has Evolved - All Good Tutorials (3)

Clinical trials confirmed that combining trastuzumab with chemotherapy slowed metastatic HER2-positive most cancers progress higher than chemotherapy alone. The FDA permitted trastuzumab in 1998.

Later, scientific trials confirmed the identical leads to individuals with early-stage HER2-positive breast most cancers. In 2006, the FDA permitted trastuzumab as an adjuvant remedy for treating early-stage HER2-positive breast most cancers. Adjuvant remedy is given after surgical procedure to kill any remaining most cancers cells. According to the National Cancer Institute, trastuzumab has improved early-stage HER2-positive breast most cancers survival charges by more than 30 percent.

Trastuzumab Treatment Today

Trastuzumab is a typical selection for treating early-stage HER2-positive breast most cancers. This drug could also be mixed with chemotherapy earlier than surgical procedure as a neoadjuvant remedy to assist shrink tumors or used after surgical procedure as an adjuvant remedy — or each.

(Video) Health Tips - HER2-Positive Breast Cancer

Trastuzumab is given intravenously (by way of a vein) at an infusion middle or a hospital for 30 to 90 minutes. It will be given with a number of chemotherapy regimens, equivalent to:

  • Cyclophosphamide (Cytoxan)
  • Anthracyclines, together with doxorubicin (Adriamycin)
  • Carboplatin (Paraplatin)
  • Taxanes, together with docetaxel (Taxotere) and paclitaxel (Taxol)

Researchers proceed to seek out new and higher methods to make use of trastuzumab and mix it with different therapies to enhance responses. Not solely are these mixtures more practical, however some formulations are additionally now accessible as injections. These therapies are extra handy and are typically higher tolerated.

2017-2020: Additional Targeted Therapies


Pertuzumab (Perjeta), one other monoclonal antibody, works in a barely completely different method than trastuzumab does. This newer drug blocks HER2 from sending progress alerts. Pertuzumab was initially permitted in 2012 for treating HER2-positive metastatic breast most cancers together with trastuzumab and docetaxel.

Later, researchers ran studies investigating the identical drug combo in individuals with early-stage HER2-positive breast most cancers who had been at a better danger of recurrence. Many of those individuals had hormone receptor-negative breast most cancers, which means their most cancers cells didn’t have progesterone or estrogen receptors. These cancers are tougher to deal with as a result of they’ve fewer receptors to dam with completely different therapies.

The scientific trials confirmed that therapy with pertuzumab, trastuzumab, and chemotherapy prevented recurrence higher than trastuzumab and chemotherapy. In 2017, the FDA permitted the triplet remedy for treating early-stage HER2-positive breast most cancers.


Other medicines used to deal with many sorts of most cancers embody tyrosine kinase inhibitors (TKIs). This class of medication prevents sure proteins generally known as tyrosine kinases from sending progress alerts to most cancers cells. HER2 is one instance of a tyrosine kinase.

How Early-Stage HER2-Positive Breast Cancer Treatment Has Evolved - All Good Tutorials (4)

(Video) Metastatic HER2-Positive Breast Cancer: Newer and Emerging Treatment Considerations

Neratinib (Nerlynx) is a TKI that blocks HER2 and different proteins. The FDA permitted neratinib in 2017 to stop recurrence in individuals with early-stage HER2-positive breast most cancers that had been handled with surgical procedure and trastuzumab for a minimum of one 12 months. Neratinib is often prescribed to be taken for one 12 months.

Ado-Trastuzumab Emtansine

Researchers have additionally found lately that monoclonal antibodies can ship different medicines on to tumor cells. These pairings of a supply antibody and a drug are generally known as antibody-drug conjugates (ADCs), they usually’re used to deal with a number of sorts of most cancers.

How Early-Stage HER2-Positive Breast Cancer Treatment Has Evolved - All Good Tutorials (5)

The ADC ado-trastuzumab emtansine (Kadcyla), also referred to as T-DM1, combines trastuzumab with the chemotherapy drug emtansine (DM1). This medicine each blocks HER2 from sending progress alerts and delivers chemotherapy on to breast most cancers cells.

The FDA permitted ado-trastuzumab emtansine in 2019 for treating early-stage HER2-positive breast most cancers. Specifically, this drug is used as an adjuvant remedy, whereas trastuzumab and chemotherapy are given earlier than surgical procedure to assist shrink the tumor. ADCs are typically higher tolerated, resulting in fewer unintended effects, than conventional chemotherapy medication.


Trastuzumab/hyaluronidase-oysk (Herceptin Hylecta) is a type of trastuzumab given by subcutaneous injection (beneath the pores and skin) reasonably than intravenous (IV) infusion. Hyaluronidase is an enzyme that thins the connective tissue the place the drug is injected, which helps the physique higher soak up the medicine. Every three weeks, this therapy plus chemotherapy is given for 2 to 5 minutes — a lot sooner than an IV infusion of trastuzumab, which may take as much as an hour and a half.

Results from scientific trials present that the injectable type of trastuzumab is as secure and efficient as IV trastuzumab. In 2019, the FDA permitted trastuzumab/hyaluronidase-oysk for treating HER2-positive breast most cancers that both has unfold to the lymph nodes (node-positive) or hasn’t unfold (node-negative) however has a excessive danger of recurrence. Injectable therapies proceed to be an efficient and less complicated therapy choice for early-stage breast most cancers.

(Video) Adjuvant therapy for early stage ER-positive, HER2-negative invasive breast cancer

Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf

A mix of pertuzumab, trastuzumab, and hyaluronidase-zzxf given with chemotherapy can shrink a tumor earlier than surgical procedure or kill the remaining most cancers cells after surgical procedure. This mixture of medication was initially given intravenously in an infusion clinic — like chemotherapy — and receiving a dose might take so long as eight hours.

In 2020, the FDA permitted Phesgo, an injectable mixture of pertuzumab, trastuzumab, and hyaluronidase-zzxf, for treating early-stage or metastatic HER2-positive breast most cancers. With this new formulation, the mix drug will be administered at residence by a well being care skilled in minutes as a subcutaneous (beneath the pores and skin) injection. It now not requires a visit to an infusion middle lasting a number of hours. Clinical research have discovered that this remedy is as secure and efficient as IV pertuzumab and trastuzumab.

Other Therapies for HER2-Positive Breast Cancer

Several different focused therapies can be found to deal with HER2-positive breast most cancers. Some are permitted for treating most cancers that has unfold to different components of the physique, and others could also be used when surgical procedure isn’t attainable. If your early-stage breast most cancers progresses or returns, chances are you’ll obtain considered one of these therapies. Examples embody:

  • Fam-trastuzumab deruxtecan-nxki (Enhertu) — An ADC that’s used to deal with metastatic HER2-positive breast most cancers or early-stage most cancers that returned inside six months of finishing therapy
  • Tucatinib (Tukysa) — A TKI that’s used to deal with HER2-positive breast most cancers that may’t be handled with surgical procedure or has metastasized
  • Lapatinib (Tykerb) — A TKI that’s used to deal with superior HER2-positive breast most cancers, normally given with the chemotherapy medication capecitabine and trastuzumab
  • Margetuximab-cmkb (Margenza) — A monoclonal antibody much like trastuzumab that’s used with chemotherapy in metastatic HER2-positive breast most cancers

New therapies for treating HER2-positive breast most cancers proceed to be studied in scientific trials. Doctors and researchers hope these advances will preserve bettering survival charges with much more tolerable and simply administered remedies.

Talk With Others Who Understand

MyBCTeam is the social community for individuals with breast most cancers and their family members. On MyBCTeam, greater than 61,000 members come collectively to ask questions, give recommendation, and share their tales with others who perceive life with breast most cancers.

What sorts of therapies have you ever acquired for HER2-positive breast most cancers? Do you continue to have questions on how early-stage HER2-positive breast most cancers is handled? Start a dialog by posting in your Activities web page.


    What are the new developments in the treatment of HER2-positive breast cancer? ›

    Metastatic HER2-positive breast cancer patients are achieving better survival rates upon treatment with anti-HER2 therapies than patients with HER2-negative disease. Double HER2 blockade with trastuzumab and pertuzumab combined with a taxane achieved an unprecedented survival of over 57 months in first-line patients.

    Is early HER2-positive breast cancer curable? ›

    With the development of HER2-targeted agents, HER2-positive breast cancer is now a treatable disease and outcomes have dramatically improved for these patients. Currently, survival rates exceed 90 percent in HER2-positive breast cancer that is diagnosed early and treated with chemotherapy and dual antibody therapy.

    What is the first-line treatment for HER2-positive breast cancer? ›

    Dual blockade with trastuzumab and pertuzumab in combination with chemotherapy is the recommended first-line therapy for human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (mBC).

    What is early stage HER2-positive breast cancer? ›

    A positive test for HER2 means breast cancer may grow quickly and possibly come back (recur). This risk is significantly lowered with appropriate treatment. At the Abramson Cancer Center, we treat HER2-positive breast cancer with medications that work to slow or stop tumor growth.

    What is the gold standard treatment for HER2-positive breast cancer? ›

    Pertuzumab (Perjeta) treats HER2-positive early breast cancer, usually in combination with trastuzumab and chemotherapy. It's FDA-approved for neoadjuvant and adjuvant treatment.

    When is HER2-positive breast cancer most likely to recur? ›

    Triple-negative and HER2 [human epidermal growth factor receptor 2]–positive tend to recur early if they do relapse, usually in the first 2 to 3 years.

    What percentage of HER2-positive breast cancer is recurrence? ›

    HER2-positive breast cancer is a highly heterogeneous tumor, and about 30% of patients still suffer from recurrence and metastasis after trastuzumab targeted therapy.

    What is the life expectancy of HER2-positive breast cancer? ›

    According to the National Cancer Institute , HER2-positive breast cancer that has not spread to any other organs in the body or the axillary lymph nodes has a 5-year relative survival rate of 98.8% if it is HR-positive and 97.3% if it is HR-negative.

    Is chemo always recommended for HER2-positive breast cancer? ›

    Because HER2-positive cancer is considered more aggressive than HER2-negative breast cancer, it is usually treated with chemotherapy after surgery to reduce recurrence risk.

    What is the first line treatment for hormone positive breast cancer? ›

    The first-line treatment for advanced hormone receptor-positive (estrogen receptor-positive or progesterone receptor-positive) breast cancer is usually hormone therapy. Current front-line therapy is typically an aromatase inhibitor (anastrozole, letrozole, or exemestane) in combination with a CDK 4/6 inhibitor.

    How effective is Herceptin to HER2-positive breast cancer? ›

    Bottomline: Herceptin plus chemotherapy for Adjuvant breast cancer treatment: 6.78% more patients are still disease free in patients that used Herceptin with chemotherapy. overall estimated median survival is 7.5% higher in the Herceptin with chemotherapy group.

    Is HER2-positive breast cancer considered metastatic? ›

    About 20% of breast cancers are HER2-positive. They usually grow quicker than other types of cancer. Metastatic HER2-positive breast cancer has spread beyond the breast to other parts of the body.

    Which chemo is best HER2-positive breast cancer? ›

    HER2-positive tumors

    If a tumor is HER2-positive, the HER2-targeted therapy drug trastuzumab (Herceptin) is included in the chemotherapy regimen. Sometimes other drugs that target HER2 are used. Pertuzumab (Perjeta) can be combined with trastuzumab, and neratinib (Nerlynx) can be given after trastuzumab.

    What foods should I avoid with HER2-positive breast cancer? ›

    HER2-positive breast cancer is a type where the HER2 receptor is over-expressed on the cancer cells. Research suggests foods like saturated fat, red meat, sugary foods, and alcohol may increase the risk for breast cancer. Some foods that may help lower cancer risk include citrus fruits, soy, omega-3s, and turmeric.

    Does HER2-positive spread faster? ›

    HER2-positive breast cancer can grow and spread faster than other breast cancers because HER2 protein speeds that growth.

    What is the best treatment for estrogen receptor positive breast cancer? ›

    In this case, if your breast cancer is oestrogen receptor positive, your doctor might recommend hormone therapy. This treatment won't get rid of the cancer but can stop it growing or shrink it. The treatment can often control the cancer for some time.

    What is the gold standard for early breast cancer? ›

    But when a mammogram is "questionable" and requires further evaluation, a Magnetic Resonance Imaging scan of the breast is considered the "gold standard" option for confirming or eliminating the presence of breast cancer.

    How do you prevent estrogen positive breast cancer recurrence? ›

    If you were diagnosed with hormone receptor-positive, early-stage breast cancer, it's likely that your doctor will recommend you take some type of hormonal therapy medicine — either tamoxifen or an aromatase inhibitor depending on your menopausal status — for five to 10 years after surgery.

    How long is treatment for HER2-positive? ›

    Neoadjuvant therapy is typically administered for between 12 and 20 weeks, depending on the chosen regimen, and followed by surgery. When given as adjuvant chemotherapy following surgery, trastuzumab is given concurrently with chemotherapy, then continued for a total duration of 12 months.

    How often does HER2 breast cancer spread to the brain? ›

    About 10% to 15% of people with stage IV breast cancer have brain metastases. The risk of brain metastasis is usually highest for people with more aggressive subtypes of breast cancer, such as HER2-positive or triple-negative breast cancer.

    What percentage of early breast cancer survivors have a recurrence? ›

    According to the Susan G. Komen® organization, women with early breast cancer most often develop local recurrence within the first five years after treatment. On average, 7 percent to 11 percent of women with early breast cancer experience a local recurrence during this time.

    What type breast cancer has the highest recurrence rate? ›

    Aggressive, hard-to-treat breast cancers, such as inflammatory breast cancer (IBC) and triple-negative breast cancer (TNBC), are the types most likely to recur.

    Is Stage 2 breast cancer likely to come back? ›

    Stage 2 breast cancer generally has a good prognosis and can be cured with treatments. On average, 7 to 11 percent of women with early breast cancer may experience a local recurrence in the first five years following treatment.

    When are you considered cancer free after breast cancer? ›

    If you remain in complete remission for five years or more, some doctors may say that you are cured, or cancer-free.

    When are you considered in remission from breast cancer? ›

    Remission is when the signs and symptoms of cancer have gone down or gone away. If you had a tumor in your breast and it shrank from successful treatment, your cancer is in remission. Your doctor may also use the word response, which means the same thing. Remission doesn't mean you're cured.

    Is HER2-positive breast cancer more aggressive? ›

    In about 1 of every 5 breast cancers, the cancer cells have extra copies of the gene that makes the HER2 protein. HER2 -positive breast cancers tend to be more aggressive than other types of breast cancer.

    Where does HER2 breast cancer usually spread to? ›

    Usually in HER2-positive metastatic breast cancer, common places of spread include the liver, lung, bones, lymph nodes, and unfortunately the brain.

    Who is more likely to have HER2-positive breast cancer? ›

    Additionally, HER2 positive cancer – which makes up about 20 percent of breast cancer cases – is more likely to affect younger women.

    Is estrogen positive breast cancer easier to treat? ›

    ER-positive breast cancer has a high chance of being successfully treated, especially when it's discovered early. A diagnosis at a later stage will have a less positive outlook, but being diagnosed at a later stage is less common.

    Can you skip hormone therapy for breast cancer? ›

    Postmenopausal women diagnosed with hormone-receptor-positive disease are 35% to 61% more likely to have breast cancer come back if they don't take hormonal therapy as prescribed. Why?

    What is the 5 year pill for breast cancer? ›

    Letrozole helps stop your breast cancer coming back. By taking this medicine for 5 years (or sometimes up to 10 years), you have a better chance of being alive 15 years after your breast cancer was first diagnosed. Your specialist will be able to explain the benefits and risks of taking letrozole.

    How well tolerated is Herceptin? ›

    Herceptin is a well-tolerated drug and the side-effects that are commonly seen with chemotherapy, such as neutropenia, alopecia and mucositis, are rarely observed.

    What is the cause of HER2-positive breast cancer? ›

    As with all types of breast cancer, what exactly causes HER2-positive breast cancer is unknown. It's likely a combination of risk factors, including lifestyle and environment. Genetics are also thought to play a role. However, the HER2 gene is not inherited from parents and can't be passed on to children.

    What is the most favorable breast cancer? ›

    Breast tumours that are smaller than 1 cm and have not spread to the lymph nodes have a very favourable prognosis.

    What breast cancer is the hardest form of breast cancer to treat? ›

    Triple-negative breast cancer (TNBC) is a rare type of breast cancer. It is harder to treat and much more aggressive. Because it is aggressive and rare, fewer treatment options are available. It also tends to have a higher rate of recurrence.

    What is the new cancer pill for breast cancer? ›

    The new drug, elacestrant, addresses a significant unmet need. It is the first and only treatment approved specifically to fight breast cancers with mutations in an estrogen receptor called ESR1, which make breast cancers resistant to standard endocrine therapy.

    Is oatmeal good for HER2-positive breast cancer? ›

    Melatonin, which is found in almonds, cherries, tomatoes, walnuts and oats, has been shown to induce apoptosis (programmed cell death) and reduce proliferation of HER2+ breast cancer cells.

    What supplements should be avoided with breast cancer? ›

    Supplements to Avoid

    “There are supplements known to interfere with anti-hormonal agents used for breast cancer.” If you take tamoxifen, it's best to avoid red clover, St. John's wort, and black cohosh. Also skip DHEA, licorice, and red clover, because they may affect your hormone levels.

    What superfoods are against breast cancer? ›

    Strawberry, blueberries, cranberries, and raspberry extracts are rich in antioxidants (vitamin C, flavonoids, anthocyanins, and ellagic acid) and slow the growth of cancer cells in the skin, bladder, lung, esophagus and breast.

    Is early stage HER2 curable? ›

    HER2-positive breast cancer is highly curable because of the availability of these HER2-targeted therapies, so we treat patients fairly aggressively upfront to reduce the risk of them experiencing a stage IV recurrence.

    Is a 2 cm breast tumor big? ›

    Cancers of exactly 2 cm in size occupy a special niche in breast oncology. That size is the one at which breast cancer is most commonly diagnosed (the “modal size”) and 2.0 cm marks the boundary between stage i and ii for node-negative breast cancers and between stage ii and iii for node-positive breast cancers.

    Is HER2-positive a high grade? ›

    HER2 cancers, however, are often high grade tumors in stage III at the time of diagnosis.

    What is the second line treatment for HER2-positive metastatic breast cancer? ›

    For people with advanced breast cancer that has grown during or after first-line treatment with a HER2-targeted therapy, ASCO recommends trastuzumab deruxtecan as a second-line treatment.

    What are the best chemo drugs for HER2-positive breast cancer? ›

    Trastuzumab (Herceptin) and pertuzumab (Perjeta) are the most commonly used drugs used to treat HER2-positive breast cancer. Neratinib (Nerlynx) is another drug that is sometimes given after trastuzumab.

    Is there a role for immunotherapy in HER2-positive breast cancer? ›

    Anti-HER2-targeted drugs combined with immune checkpoint inhibitors are a promising new strategy for the treatment of HER2+ breast cancer. Preclinical studies show immunotherapy may enhance the efficacy of anti-HER2 therapy.

    What is the new molecule that cures breast cancer? ›

    “The ERX-41 compound did not kill healthy cells, but it wiped out tumor cells regardless of whether the cancer cells had estrogen receptors,” Ahn said. “In fact, it killed the triple-negative breast cancer cells better than it killed the ER-positive cells.

    What is the prognosis of HER2 breast cancer? ›

    According to the National Cancer Institute , HER2-positive breast cancer that has not spread to any other organs in the body or the axillary lymph nodes has a 5-year relative survival rate of 98.8% if it is HR-positive and 97.3% if it is HR-negative.

    Which breast cancer responds best to chemo? ›

    Larger cancers and higher grade cancers are more likely to recur and are more likely to benefit from chemotherapy. Lymph node status. If your breast cancer has spread to your lymph nodes, your doctor may recommend chemotherapy.

    What is the monoclonal antibody therapy for HER2 breast cancer? ›

    Pertuzumab (Perjeta): This HER2 monoclonal antibody can be given with trastuzumab and chemo, either before or after surgery to treat early-stage breast cancer, or to treat advanced breast cancer. This drug is given into a vein (IV).

    What is the miracle cure for breast cancer? ›

    Most women with breast cancer are aware of the "miracle drug" Herceptin/Trastuzumab. It has changed the prognosis for women with this kind of breast cancer from an often lethal disease to one that can often be effectively treated.

    What stops cancer cells from growing? ›

    Tyrosine kinase inhibitors (TKIs) block chemical messengers (enzymes) called tyrosine kinases. Tyrosine kinases help to send growth signals in cells, so blocking them stops the cell growing and dividing. Cancer growth blockers can block one type of tyrosine kinase or more than one type.

    What kills cancer cells in the body? ›

    Oncolytic viruses kill individual cancer cells, but studies also suggest that they can boost the immune system's ability to recognize and kill a tumor. The viruses enter tumor cells specifically and replicate, eventually breaking the cells apart.


    1. Understanding and Treating HER2+ Breast Cancer
    (SHARE Cancer Support)
    2. HER2 Positive Breast Cancer Management
    (Community Health Resource Center CPMC)
    3. Navigating the Expanding Treatment Arsenal for ER+/HER2- Breast Cancer
    (PeerView Oncology)
    4. HER2 In Breast Cancer: Testing Guidelines and New Treatment Approaches
    5. Medical Update: HER2-Positive Metastatic Breast Cancer
    (Living Beyond Breast Cancer)
    6. “Path to Success in HER2 Positive Breast Cancer” by Sandra M. Swain, MD, FACP, FASCO
    (UH Medicine)


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