A Practical Clinical Approach to Adjuvant Therapy in Breast Cancer—An Update

2009 ◽  
Vol 05 (01) ◽  
pp. 49
Author(s):  
Stephanie L Hines ◽  
Winston Tan ◽  
Alvaro Moreno-Aspitia ◽  
Vivek Roy ◽  
Laura A Vallow ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Molecular Markers ◽  
Adjuvant Therapy ◽  
Potential Benefit ◽  
Recurrence Risk ◽  
Clinical Approach ◽  
Her2 Positive ◽  
Heterogeneous Nature ◽  
The Individual ◽  
Disease Specific

Adjuvant therapy for breast cancer has evolved to reflect the heterogeneous nature of the disease. Specific subtypes such as luminal, HER2- positive, and basal subtypes express different molecular markers that can be targeted by a variety of novel agents; therapy is tailored to the individual profile of each tumor. New risk-stratification models, including models based on a tumor’s genetic expression, enhance assessments of recurrence risk so that the potential toxicities of a particular regimen can be weighed against the potential benefit. More precise tailoring of adjuvant therapy may be possible in the future with advances in pharmaco-genetics, which will help to predict an individual’s response to various agents. Optimal adjuvant treatment of breast cancer involves tailoring therapy to the individual patient and tumor.

scholarly journals Role of Post-Neoadjuvant therapy with trastuzumab emtansine in HER2-positive breast cancer

2021 ◽  
pp. 68-74
Author(s):  
E. V. Lubennikova ◽  
Ya. V. Vishnevskaya
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Neoadjuvant Therapy ◽  
Locally Advanced ◽  
Residual Tumor ◽  
Long Term Results ◽  
Trastuzumab Emtansine ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Positive Breast Cancer

The widespread introduction of anti-HER2 agents has changed the natural course of Her2-positive breast cancer. The use of trastuzumab, and later dual anti-HER2 blockade with pertuzumab, in neoadjuvant regimens significantly increased the chances of complete cure. However, among patients with early and locally advanced forms of Her2-positive cancer, there is a cohort with an extremely unfavorable prognosis – tumors that have not achieved complete pathomorphological regression after neoadjuvant chemotherapy.The presence of a residual tumor in Her2-positive breast cancer has long been only a prognostically unfavorable factor without the potential to influence disease outcome. The results of the international phase III study KATHERINE, which demonstrated the high efficacy of post-adjuvant therapy with trastuzumab emtansine (T-DM1) in this patient cohort, have established a new standard of care. Due to T-DM1 adjuvant therapy, the possibility to significantly improve long-term results determined the predictive characteristics of the morphological response to the choice of treatment tactics, which became an important argument in favor of neoadjuvant therapy in patients with not only locally advanced but also primarily resectable Her2-positive breast cancer, followed by personalization of therapy.This article presents our own experience with post-neoadjuvant therapy with trastuzumab emtansine in a young patient with a residual tumor. The data of the main studies in early Her2-positive breast cancer are summarized.

scholarly journals Adjuvant breast cancer: (neo)adjuvant therapy for HER2-positive breast cancer

2019 ◽  
Vol 12 (4) ◽  
pp. 312-314 ◽  
Author(s):  
Christoph Suppan ◽  
Marija Balic
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Annual Meeting ◽  
Early Stage ◽  
Postoperative Treatment ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Adjuvant Breast Cancer ◽  
American Society ◽  
Positive Breast Cancer

Summary Early stage HER2-positive cancer outcomes have been substantially improved over the last two decades, but there is still some potential for improvement. Several studies on the preoperative/postoperative treatment of HER2-positive breast cancer were presented at the American Society of Clinical Oncology (ASCO) 2019 annual meeting.

scholarly journals The Promher Study: An Observational Italian Study on Adjuvant Therapy for HER2-Positive, pT1a-b pN0 Breast Cancer

PLoS ONE ◽  
2015 ◽  
Vol 10 (9) ◽  
pp. e0136731 ◽  
Author(s):  
Stefania Gori ◽  
Alessandro Inno ◽  
Elena Fiorio ◽  
Jennifer Foglietta ◽  
Antonella Ferro ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Her2 Positive ◽  
Italian Study

Survey of breast cancer patients concerning their knowledge and expectations of adjuvant therapy.

1998 ◽  
Vol 16 (2) ◽  
pp. 515-521 ◽  
Author(s):  
P M Ravdin ◽  
I A Siminoff ◽  
J A Harvey
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Quantitative Estimate ◽  
Breast Cancer Survivors ◽  
Treatment Guidelines ◽  
Recurrence Risk ◽  
The United States ◽  
Breast Cancer Patients ◽  
Net Benefit ◽  
Quantitative Estimates

PURPOSE A survey of breast cancer survivors in the United States was conducted to define what they had been told about their prognosis and the value of adjuvant therapy, what they estimated their prognosis to be with and without adjuvant therapy, and what level of improvement they would have found minimally worthwhile. MATERIALS AND METHODS Survey questionnaires were mailed to individual members and member organizations of the National Alliance of Breast Cancer Organizations (NABCO). Questionnaires were returned anonymously in prepaid mailers. Five hundred sixty-two women responded. Of these, the 318 women who received adjuvant chemotherapy were included in this analysis. RESULTS Only 39% of the women recalled receiving quantitative estimates of their prognosis, and only 31% of women received a quantitative estimate both with and without adjuvant therapy. Sixty-eight percent of the women were able to provide a quantitative estimate for their outcome at 5 years both with and without adjuvant therapy. From these estimates, we calculated that the median estimated proportional risk reduction for recurrence that women thought they had achieved was 79%. Women were asked what degree of absolute benefit they would have found acceptable. The median acceptable extension of life expectancy was 3 to 6 months, and acceptable reduction in recurrence risk was 0.5% to 1.0%. However, there was considerable variation, with 27% of women not accepting less than 1 year and 26% not accepting a less than 5% reduction in recurrence risk. CONCLUSION In general, American women in the surveyed population (1) do not recall being provided quantitative estimates of outcome during the process of making decisions about adjuvant therapy, (2) overestimate the value of their therapy, and (3) often will accept remarkably low degrees of net benefit. Overall, these observations can be used to support the argument that improvements in doctor/patient communication may be important to truly informed decision-making, and that flexibility for individual patients' preferences should not be superseded by rigid treatment guidelines.

scholarly journals Adding pertuzumab to adjuvant therapy for high-risk HER2-positive early breast cancer in APHINITY: a GRADE analysis

2020 ◽  
Vol 9 (6) ◽  
pp. 423-430 ◽  
Author(s):  
Alberto Zambelli ◽  
Giovanni Pappagallo ◽  
Paolo Marchetti
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Adjuvant Therapy ◽  
Early Breast Cancer ◽  
Disease Free Survival ◽  
Invasive Disease ◽  
Her2 Positive ◽  
Free Survival ◽  
Distant Relapse ◽  
Disease Free

Aim: Adding pertuzumab to standard trastuzumab-based adjuvant therapy significantly improved invasive disease-free survival (IDFS) in the APHINITY trial. However, the magnitude of benefit was marginal in the overall population. Methods: We used GRADE (Grading of Recommendations Assessment, Development and Evaluation) analysis on data from APHINITY to build summary-of-findings tables to evaluate the efficacy, safety and quality of evidence of predefined clinical outcomes for the addition of pertuzumab to trastuzumab-based adjuvant therapy in patients with high-risk HER2-positive early breast cancer. Results: Pertuzumab significantly improved 3-year, event-free, absolute benefit in disease-free survival, IDFS and distant relapse-free interval (DFRI) in patients with node-positive or hormone receptor-negative disease. The analysis provides strength of evidence supporting the addition of pertuzumab in this patient population.

scholarly journals PCN4 BUDGET IMPACT ANALYSIS OF ADJUVANT THERAPY WITH TRASTUZUMAB FOR HER2-POSITIVE EARLY BREAST CANCER IN POLISH SETTING

2007 ◽  
Vol 10 (3) ◽  
pp. A124
Author(s):  
E Orlewska ◽  
R Aultman ◽  
M Krzakowski ◽  
T Pienkowski ◽  
K Drosik ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adjuvant Therapy ◽  
Early Breast Cancer ◽  
Impact Analysis ◽  
Budget Impact ◽  
Budget Impact Analysis ◽  
Her2 Positive
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