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Current Oncology is published by MDPI from Volume 28 Issue 1 (2021). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Multimed Inc..
Review

Systemic Targeted Therapy for her2-Positive Early Female Breast Cancer: A Systematic Review of the Evidence for the 2014 Cancer Care Ontario Systemic Therapy Guideline

1
Cancer Centre of Southeastern Ontario, Kinston General Hospital, Queen’s University, Kingston, ON, Canada
2
Program in Evidence-Based Care, Cancer Care Ontario, Department of Oncology, McMaster University, Hamilton, ON, Canada
3
Durham Regional Cancer Centre, Oshawa, ON, Canada
4
Sunnybrook Health Science Centre, Toronto, ON, Canada
5
The Ottawa Hospital Cancer Centre and University of Ottawa, Ottawa, ON, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2015, 22(s1), 114-122; https://doi.org/10.3747/co.22.2322
Received: 9 December 2014 / Revised: 6 January 2015 / Accepted: 3 February 2015 / Published: 1 March 2015
Background: This systematic review addresses the question “What is the optimal targeted therapy for female patients with early-stage human epidermal growth factor receptor 2 (her2)–positive breast cancer?” Methods: The medline and embase databases were searched for the period January 2008 to May 2014. The Standards and Guidelines Evidence directory of cancer guidelines and the Web sites of major guideline organizations were also searched. Results: Sixty publications relevant to the targeted therapy portion of the systematic review were identified. In four major trials (hera, National Surgical Adjuvant Breast and Bowel Project B-31, North Central Cancer Treatment Group N9831, and Breast Cancer International Research Group 006), adjuvant trastuzumab for 1 year was superior in disease-free survival (dfs) and overall survival (os) to no trastuzumab; trastuzumab showed no benefit in one trial (pacs 04). A shorter duration of trastuzumab (less than 1 year compared with 1 year) was evaluated, with mixed results for dfs: one trial showed superiority (finher), one trial could not demonstrate noninferiority (phare), another trial showed equivalent results (E 2198), and one trial is still ongoing (persephone). Longer trastuzumab duration (hera: 2 years vs. 1 year) showed no improvement in dfs or her and a higher rate of cardiac events. Newer her2-targeted agents (lapatinib, pertuzumab, T-DM1, neratinib) have been or are still being evaluated in both adjuvant and neoadjuvant trials, either by direct comparison with trastuzumab alone or combined with trastuzumab. In the neoadjuvant setting (neoaltto, GeparQuinto, Neosphere), trastuzumab alone or in combination with another anti-her2 agent (lapatinib, pertuzumab) was compared with either lapatinib or pertuzumab alone and showed superior or equivalent rates of pathologic complete response. In the adjuvant setting, lapatinib alone or in combination with trastuzumab, compared with trastuzumab alone (altto) or with placebo (teach), was not superior in dfs. The results of the completed aphinity trial, evaluating the role of dual her2 blockade with trastuzumab and pertuzumab, are highly anticipated. Ongoing trials are evaluating trastuzumab as a single agent without adjuvant chemotherapy (respect) and in patients with low her2 expression (National Surgical Adjuvant Breast and Bowel Project B-47). Conclusions: Taking into consideration disease characteristics and patient preference, 1 year of trastuzumab should be offered to all patients with her2-positive breast cancer who are receiving adjuvant chemotherapy. Cardiac function should be regularly assessed in this patient population.
Keywords: early breast cancer; her2; targeted therapy; trastuzumab; lapatinib; pertuzumab early breast cancer; her2; targeted therapy; trastuzumab; lapatinib; pertuzumab
MDPI and ACS Style

Mates, M.; Fletcher, G.G.; Freedman, O.C.; Eisen, A.; Gandhi, S.; Trudeau, M.E.; Dent, S.F. Systemic Targeted Therapy for her2-Positive Early Female Breast Cancer: A Systematic Review of the Evidence for the 2014 Cancer Care Ontario Systemic Therapy Guideline. Curr. Oncol. 2015, 22, 114-122. https://doi.org/10.3747/co.22.2322

AMA Style

Mates M, Fletcher GG, Freedman OC, Eisen A, Gandhi S, Trudeau ME, Dent SF. Systemic Targeted Therapy for her2-Positive Early Female Breast Cancer: A Systematic Review of the Evidence for the 2014 Cancer Care Ontario Systemic Therapy Guideline. Current Oncology. 2015; 22(s1):114-122. https://doi.org/10.3747/co.22.2322

Chicago/Turabian Style

Mates, M., G.G. Fletcher, O.C. Freedman, A. Eisen, S. Gandhi, M.E. Trudeau, and S.F. Dent 2015. "Systemic Targeted Therapy for her2-Positive Early Female Breast Cancer: A Systematic Review of the Evidence for the 2014 Cancer Care Ontario Systemic Therapy Guideline" Current Oncology 22, no. s1: 114-122. https://doi.org/10.3747/co.22.2322

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