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Review

Evolving Role of Risk Tailored Therapy in Early Stage HER2-Positive Breast Cancer: A Canadian Perspective

1
Division of Medical Oncology, Department of Medicine, The Ottawa Hospital, The University of Ottawa, Ottawa, ON K1H 8L6, Canada
2
Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2022, 29(6), 4125-4137; https://doi.org/10.3390/curroncol29060329
Received: 23 April 2022 / Revised: 28 May 2022 / Accepted: 31 May 2022 / Published: 6 June 2022
(This article belongs to the Special Issue Evolving Paradigm of Curative Intent Breast Cancer Management)
The advent of HER2-targeted therapies has led to an important shift in the management of HER2-positive early breast cancer. However, initial treatment approaches apply uniform treatment regimens to all patients, with significant treatment-related and financial toxicities for both the patient and the health care system. Recent data demonstrates that for many patients, the chemotherapy backbone, duration and nature (mono- versus dual-targeted therapy) of the HER2 blockade can be better targeted to an individual patient’s risk of recurrence. We will provide a review of current data supporting risk tailored therapy in early stage HER2-positive breast cancer along with key completed and ongoing Canadian and international risk tailored trials. Neoadjuvant systemic therapy should now be considered for patients with clinical stage 2 disease, with greater use of non-anthracycline based chemotherapy regimens. Patients with residual disease following neoadjuvant therapy should be considered for escalated treatment with adjuvant T-DM1. Patients with stage I disease can often be managed with upfront surgery and evidence-based de-escalated adjuvant chemotherapy regimens. The modest benefit of 12- versus 6 months of adjuvant HER2 therapy and/or dual adjuvant HER2 therapy should be carefully weighed against the toxicities. All patients with HER2-positive breast cancer should be enrolled in ongoing risk tailored treatment trials whenever possible. Increasing data supports risk tailored therapy in early stage HER2-positive breast cancer in place of the routine application of aggressive and toxic systemic therapy regimens to all patients. While much progress has been made towards treatment de-escalation in appropriate patients, more is needed, as we highlight in this review. Indeed, Canadian-led clinical trials are helping to lead these efforts. View Full-Text
Keywords: HER2-positive breast cancer; adjuvant; neoadjuvant; de-escalation HER2-positive breast cancer; adjuvant; neoadjuvant; de-escalation
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MDPI and ACS Style

McGee, S.F.; Clemons, M.; Savard, M.-F. Evolving Role of Risk Tailored Therapy in Early Stage HER2-Positive Breast Cancer: A Canadian Perspective. Curr. Oncol. 2022, 29, 4125-4137. https://doi.org/10.3390/curroncol29060329

AMA Style

McGee SF, Clemons M, Savard M-F. Evolving Role of Risk Tailored Therapy in Early Stage HER2-Positive Breast Cancer: A Canadian Perspective. Current Oncology. 2022; 29(6):4125-4137. https://doi.org/10.3390/curroncol29060329

Chicago/Turabian Style

McGee, Sharon F., Mark Clemons, and Marie-France Savard. 2022. "Evolving Role of Risk Tailored Therapy in Early Stage HER2-Positive Breast Cancer: A Canadian Perspective" Current Oncology 29, no. 6: 4125-4137. https://doi.org/10.3390/curroncol29060329

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