There Are Several Targeted Therapy Options Available
If you have HER2-positive breast cancer, your options for treatment will depend on several factors, such as the stage of cancer and the hormone receptor status of the tumor.
HER2-positive tumors can also be estrogen-receptor-positive . However, a tumor’s receptor status can change . Therefore, the treatment plan your oncologist recommends might change as well.
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It’s believed that around 20-25% of newly diagnosed cases of breast cancers are positive for a genetic mutation that causes HER2 gene amplification. The mutation causes the gene to produce too many HER2/neu proteins .
In normal amounts, these proteins act as receptors that tell the breast cells how much to grow . When the mutation is present, the overproduction of HER2 proteins drives the growth of breast cancer cells.
Therapies that specifically target HER2 include Herceptin , Perjeta , and T-DM1 which is sold under the brand nameKadcycla.
Verywell / Ellen Lindner
Her2 Positive Breast Cancer
Breast tissue sampled by a biopsy or after surgery is sent to a pathologist who will report on several features in the sample, including the status of molecular markers such as the estrogen receptor, progesterone receptor and HER2 . These results will help a treating clinician determine the best treatments, which may include hormonal or targeted drugs.Around 15-20% of all breast cancer cases are HER2 positive, meaning that the breast cancer cells produce excessive amounts of the HER2 protein, which promotes the growth of this type of breast cancer.
In non-cancerous cells, HER2 is responsible for normal cell growth as well as other essential cellular processes, whereas excessive levels of HER2 in cancer cells leads to fast growing tumours.
Around one in five women with breast cancer haveHER2 positive breast cancer, which can be more aggressive than someHER2 negative breast cancers. HER2 positive breast cancer may be hormone receptor positive or hormone receptor negative. This can affect the treatment chosen. HER2 positive cancers tend to spread faster than other breast cancers but are much more likely to respond to treatment with drugs that specifically target HER2 receptors. Since most HER2 positive tumours can be successfully targeted, HER2 is no longer a marker for a poor prognosis.
What Is The Outlook For Her2
As mentioned before, HER2-positive breast cancers are more likely to grow faster and to come back after treatment than cancers that are HER2-negative. However, the development of the drugs discussed above that specifically treats cancers expressing HER2 has led to significant improvements in the outlook for people with HER2-positive breast cancer.
While survival rate statistics for breast cancer are not broken down to show rates for HER2-positive cancers, the 5-year survival rate for all localized breast cancers is 99%. However, the 5-year survival rate for metastatic breast cancer is 27%, so it is important to treat HER2-positive breast cancer as early as possible to reduce or prevent spread.
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How The Vaccine Works
The study included 66 patients who were treated between 2001 and 2010. They were divided into three groups with each receiving either 10, 100, or 500 micrograms of the vaccine. Researchers administered the vaccine intradermally once a month for three months.
This DNA-based vaccine contains the genetic code to make the HER2 protein, along with other compounds that boost the immune response. The cells in the arm absorb that DNA and start pumping out copies of HER2.
The immune system recognizes the protein as foreign and dangerous and creates defense mechanisms against it. The next time the immune system encounters a cancer cell with a HER2 protein, its already primed to snuff it out.
While we can get rid of detectable cancer with standard treatment of HER2 cancer, there still may be small amounts of cells that can survive, , lead author of the study and a professor at the University of Washington School of Medicine, told Verywell in an email. The vaccine helps the immune system detect and destroy any remaining cellshelping prevent recurrence of the cancer.
After four months and nine months, researchers performed a biopsy at the site of vaccination to measure the longevity of the immune response. Those who got the highest dosage of vaccine tended to have the most lasting immune response. However, those who got the second-highest dose were more likely to survive in the decade after being immunized.
Japan Approves Trastuzumab Deruxtecan For Previously Treated Her2+ Metastatic Breast Cancer
Japans Ministry of Health, Labor, and Welfare has approved trastuzumab deruxtecan for the treatment of adult patients with HER2-positive unresectable or recurrent breast cancer after prior chemotherapy, which includes trastuzumab and a taxane.
Japans Ministry of Health, Labor, and Welfare has approved fam-trastuzumab deruxtecan-nxki for the treatment of adult patients with HER2-positive unresectable or recurrent breast cancer after prior chemotherapy, which includes trastuzumab and a taxane.1
The approval was based on data from the phase 3 DESTINY-Breast03 trial , where trastuzumab deruxtecan reduced the risk of disease progression or death by 72% compared with ado-trastuzumab emtansine . The median progression-free survival for patients treated with trastuzumab deruxtecan was not reached vs 6.8 months for T-DM1 .
We are proud of the quality and speed in which we were able to deliver a confirmatory phase 3 trial that demonstrated the superiority of in prolonging PFS compared to T-DM1 in patients with previously treated HER2 positive metastatic breast cancer, Wataru Takasaki, PhD, executive officer, head of R& D Division in Japan, Daiichi Sankyo, stated in a press release. This approval by the MHLW highlights the importance of the conditional approval system in Japan that allows for early approval of medicines to treat serious conditions such as breast cancer.
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Role Of Tumor Microenvironment In Resistance To Her2
FIGURE 3. Mechanism of anti-PD-L1 therapy. After interferon exposure, tumor cells reactively express PD-L1, which binds to PD-1 on the surface of T cells and inhibits T cells. Anti-PD-1 or anti-PD-L1 antibodies can block the interaction of PD-1 with PD-L1 and reverse the inhibition of CD8+ T cells, thereby enhancing anti-tumor activity.
TABLE 2. Clinical trials of immunotherapy combined with anti-HER2 therapy.
Treatment Of Her2+ Breast Cancer
Thanks to many years of research, an effective treatment for breast cancer is possible. This also applies to double positive breast cancer, which is one of the most difficult cancers to treat. It should be remembered that the earlier the disease is detected, the greater the chance of a cure. For this reason, prevention is so important, which allows you to detect a tumor before it begins to metastasize.
Clinical trial results have been published showing that HER2 receptor blocking therapy significantly improves breast cancer outcomes. Moreover, the use of targeted therapy at the earliest stage of cancer can reduce the size of the tumor, thus avoiding mastectomy. Thanks to targeted therapy, it is possible to carry out organ-preserving surgical treatment, which also reduces the negative psychological consequences .
Drugs that block the HER2 receptor, used as a preoperative treatment, contribute to the fact that at the first stage of treatment the patient can function normally without giving up, for example, professional activities, which is also important psychologically. The use of targeted therapies is also a good solution from an economic point of view, as it reduces the costs associated with other types of therapy. Unfortunately, the use of dual blockade of the HER2 receptor in early breast cancer is not part of the systemic treatment in Poland. Therapy is not reimbursed, which in many cases limits access to effective treatment.
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What Does Her2 Positive Mean
HER2 is a protein that helps cancer cells to grow. HER2-positive cancers make too much HER2, so the cancer may grow more quickly. There are treatments that can target HER2, which are often good at keeping the cancer under control.
Is it common for cancers to be HER2 positive?
About 1 in 5 women has HER2-positive breast cancer.
Pursuing The Causes For Fundamental Improvement
First, the economic factors.
Second, the standardized treatment.
In addition to economic factors, the clinicians treatment concept is bound to have some impact on the use of targeted drugs. Targeted therapy, as a safe and effective anti-tumor treatment, by virtue of its advantages, plays an increasingly important role in tumor treatment. It has become the choice for cancer treatment as important as surgery, radiotherapy and chemotherapy cancer treatment can be described as entering the period of targeted therapies.
Currently, many clinicians in first-tier cities have accepted the concept of targeted therapy. But relatively big gaps can still be found when comparing data on the proportion of targeted therapy in different provinces, or in different cities in a province. For example, in Guangdong province, statistical data on the rate of targeted therapy for HER2-positive breast cancer patients has revealed occurrences of 0% in some hospitals. Therefore, the advantages of targeted therapy and its importance in the overall treatment of breast cancer need to be emphasized, and the regular requirement of targeted therapy needs to be standardized to avoid any adverse effect on the patient survival as a result of poor treatment concept.
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The Fda Has Approved A New Molecularly Targeted Therapeutic For Treating Certain Patients With Advanced Or Metastatic Her2
The U.S. Food and Drug Administration has approved a new HER2-targeted therapeutic called tucatinib for treating patients who have advanced or metastatic HER2-positive breast cancer that has progressed despite treatment with one or more other HER2-targeted therapeutics.
About 15 percent of the 276,480 new cases of breast cancer expected to be diagnosed in the United States in 2020 will have elevated levels of the protein HER2. HER2-positive breast cancer tends to be aggressive, and the outcome for patients was typically poor until research led to the development and FDA approval of HER2-targeted therapeutics. Trastuzumab was the first of these groundbreaking therapeutics to be approved by the FDA, in 1998.
There are now numerous HER2-targeted therapeutics approved for treating advanced or metastatic HER2-positive breast cancer. Most patients are first treated with a combination of trastuzumab, a second HER2-targeted therapeutic called pertuzumab , and a cytotoxic chemotherapeutic. Despite the success of this combination, many patients ultimately have disease progression and new options for treating these individuals are urgently needed.
Tucatinib is a new HER2-targeted therapeutic. It has been approved by the FDA for use in combination with trastuzumab and the cytotoxic chemotherapeutic capecitabine.
The FDA approval was rendered on April 17, 2020.
Treatment For Her2 Positive Breast Cancer
HER2 positive breast cancer life expectancy is affected by many factors, including the stage at diagnosis and the treatment used. However, several effective HER2 positive breast cancer treatmentsare available for this subtype and your doctor will choose the right one/s for you based on several factors .
For most people,HER2 positive breast cancer treatment involves targeted therapies drugs that specifically aim to block HER2 protein to stop the cancer cells from growing. Patients with HER2 positive breast cancer may also receive a combination of treatments that may include surgery, radiation, chemotherapy, targeted and hormonal therapies . The drugs used for patients with HER2 positive breast cancer may include:
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The Course Of Epidermal Growth Factor Receptor 2
Breast cancer is one of malignant tumors affecting womens health. The Global Cancer Statistics published in February 2015 showed that there were around 1.67 million women suffering from breast cancer, more than 500,000 patients died of breast cancer, and the incidence and mortality all ranked first among cancers in women . According to the latest published data on cancer incidence and mortality by our National Cancer Center, the number of cases of breast cancer ranks first in female cancers, while the number of deaths of women with breast cancer ranks only sixth , indicating preliminarily, that, through the tireless efforts of scholars in the field of breast cancer for decades, our breast cancer treatment has accomplished an international standard.
Thus, at the 10th Shanghai International Forum on Breast Cancer recently organized by the Chinese Anti-Cancer Association Breast Cancer Committee , Fudan University Cancer Hospital, and the Shanghai Cancer Institute, experts and scholars in the field of breast cancer from China and the United States had an discussion and exploration on the current status of HER2-positive breast cancer treatment to promote the development of anti-HER2 targeted therapy.
Side Effects Of Herceptin
Herceptin often causes side effects, although many of these will become less severe over time.
The following side effects are experienced by around 1 in 10 people:
- a reaction to the medicine, such as chills, a high temperature, swelling of the face and lips, headache, hot flushes, feeling sick, wheezing and breathlessness
- tiredness and difficulty sleeping
Cancer Research UK also has more information about the common side effects of herceptin.
Tell your doctor if you have particularly troublesome side effects, as there may be medicines available to treat them.
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Side Effects Of Neratinib
The most common side effect of neratinib is diarrhea . Your health care provider will recommend medications to help control the diarrhea.
To learn more about neratinib, visit the National Institutes of Healths Medline Plus website.
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What Is The Treatment For Her2
Your health care team needs to evaluate all therapy and provide guidance in response to all test results available and the specific circumstances of your cancer. Treatment for HER2-positive breast cancer typically involves a combination of chemotherapy and specific drugs used for cancers expressing the HER2 protein:
- Trastuzumab : This is a monoclonal antibody against HER2, as well as the first drug developed that targets the HER2 protein.
- Pertuzumab : This is another monoclonal antibody that targets HER2-positive cancers.
- Ado-trastuzumab emtansine or TDM-1 : It’s a monoclonal antibody that is attached to a chemotherapy drug, emtansine.
- Lapatinib : Medical professionals usually use this kinase inhibitor with chemotherapy or hormone therapy.
- Neratinib interferes with the cancer cells’ ability to respond to growth signals.
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What Do The Test Results Mean
The results of HER2 testing will guide you and your cancer care team in making the best treatment decisions.
It is not clear if one test is more accurate than the other, but FISH is more expensive and takes longer to get the results. Often the IHC test is done first.
- If the IHC result is 0, the cancer is considered HER2-negative. These cancers do not respond to treatment with drugs that target HER2.
- If the IHC result is 1+, the cancer is considered HER2-negative. These cancers do not usually respond to treatment with drugs that target HER2, but new research shows that certain HER2 drugs might help in some cases .
- If the IHC result is 2+, the HER2 status of the tumor is not clear and is called “equivocal.” This means that the HER2 status needs to be tested with FISH to clarify the result.
- If the IHC result is 3+, the cancer is HER2-positive. These cancers are usually treated with drugs that target HER2.
Some breast cancers that have an IHC result of 1+ or an IHC result of 2+ along with a negative FISH test might be called HER2-low cancers. These breast cancers are still being studied but appear to benefit from certain HER2-targeted drugs.
Triple-negative breast tumors dont have too much HER2 and also dont have estrogen or progesterone receptors. They are HER2-, ER-, and PR-negative. Hormone therapy and drugs that target HER2 are not helpful in treating these cancers. See Triple-negative Breast Cancer to learn more.
Taking Care Of Yourself
Having breast cancer can be overwhelming. Remember, though: You’re in control of your treatment decisions and how you live your life.
These tips can help you stay healthy while you get treatment:
- Get the support you need. This could be information about breast cancer, talking with someone, or help with daily tasks. It can all make a huge difference in how you feel. Listen to your body. Exercise can help you feel better, but only when you’re up for it.
- Stay nourished. If you don’t have much of an appetite, eat smaller meals every few hours rather than three big meals.
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Heart Problems Linked To Trastuzumab
Trastuzumab use is linked to congestive heart failure, a serious heart condition.
In clinical trials, about 2-3 percent of those treated with chemotherapy plus trastuzumab had heart failure, compared to fewer than 1 percent of those treated with chemotherapy alone .
This risk of heart problems is higher with chemotherapy regimens that include an anthracycline drug compared to regimens without an anthracycline drug .
The risk of heart problems may also be higher for women over 60 and for those who already have heart problems .
For most people who develop a heart problem while taking trastuzumab, the condition improves after stopping trastuzumab. For a few, it may be permanent.
Avoiding heart problems
Your heart will be checked before and during treatment with trastuzumab. This is to help make sure there are no problems, or if there are problems, theyre caught early.
Adopting a lifestyle that includes a healthy diet, regular exercise and for those who smoke, quitting smoking are good ways to help avoid heart problems related to treatment.
To learn more about trastuzumab, visit the National Institutes of Healths Medline Plus website.