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Dual HER2 blockade in the neoadjuvant and adjuvant treatment of HER2-positive breast cancer

Authors Advani P, Cornell L, Chumsri S, Moreno-Aspitia A

Received 27 June 2015

Accepted for publication 28 July 2015

Published 22 September 2015 Volume 2015:7 Pages 321—335

DOI https://doi.org/10.2147/BCTT.S90627

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Yuanzhong Wang

Peer reviewer comments 2

Editor who approved publication: Professor Pranela Rameshwar

Pooja Advani,1 Lauren Cornell,2 Saranya Chumsri,1 Alvaro Moreno-Aspitia1

1Division of Hematology and Oncology, 2Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA

Abstract: Human epidermal growth factor receptor 2 (HER2) is a tyrosine kinase transmembrane receptor that is overexpressed on the surface of 15%–20% of breast tumors and has been associated with poor prognosis. Consistently improved pathologic response and survival rates have been demonstrated with use of trastuzumab in combination with standard chemotherapy in both early and advanced breast cancer. However, resistance to trastuzumab may pose a major problem in the effective treatment of HER2-positive breast cancer. Dual HER2 blockade, using agents that work in a complimentary fashion to trastuzumab, has more recently been explored to evade resistance in both the preoperative (neoadjuvant) and adjuvant settings. Increased effectiveness of dual anti-HER2 agents over single blockade has been recently reported in clinical studies. Pertuzumab in combination with trastuzumab and taxane is currently approved in the metastatic and neoadjuvant treatment of HER2-positive breast cancer. Various biomarkers have also been investigated to identify subsets of patients with HER2-positive tumors who would likely respond best to these targeted therapy combinations. In this article, available trial data regarding efficacy and toxicity of treatment with combination HER2 agents in the neoadjuvant and adjuvant setting have been reviewed, and relevant correlative biomarker data from these trials have been discussed.

Keywords: HER2, dual blockade, neoadjuvant, adjuvant, breast cancer, trastuzumab

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