HER2 positive breast cancer: Current standard therapies and their evolving role in advanced and early stage

Breast cancer is the commonest malignancy affecting women globally. It occurs when some breast cells start to develop abnormally. These cells multiply and divide more quickly than healthy cells, generating a mass or lump. At times the cells can “metastasize” (spread) through the breast to the lymph nodes or to other areas of the body. Breast cancer typically develops from cells in the ducts that produce milk (invasive ductal carcinoma). It can also start in other cells or tissues within the breast, including the glandular tissue known as lobules (invasive lobular carcinoma). 

Breast cancer accounts for 1 in 4 cancer cases in women. It has surpassed cervical cancer to reach the top spot among malignancies. Every 50 seconds, a woman in the world loses her life to this disease. Through gene expression profiling, it has become evident that breast cancer is a heterogeneous disease with at least five subtypes. Approximately 25% of breast cancers are HER2-positive, indicating an aggressive phenotype.

Furthermore, low- and middle-income countries bear a disproportionate share of the disease burden. In India, we often encounter younger patients with more aggressive biology, advanced disease upon diagnosis, and thus a poorer outcome. All of this is a cause for concern.

However, there have been few advancements in the medical field over the years that have proven beneficial for breast cancer cases such as:

• In high-income countries, there has been a 40% decrease in breast cancer-related fatalities since 1980s.
• The availability of considerably more effective treatments due to rapid scientific advancements allows people with breast cancer to live longer and in much better conditions
• With medical advances, we can now molecularly distinguish between different forms of breast cancer and provide our patients with medication that is specific to their disease
• In addition to chemotherapy and hormone therapy, we now have other treatment options such as CDK inhibitors, PARP inhibitors, antibody-drug conjugates, immunotherapy, etc. For breast cancer patients, several of these therapies have changed everything
• One of the most recent developments for patients with breast cancer, PHESGO, a combination of two chemotherapy medications which is an injection delivered in the patient’s thigh and only takes 5-8 minutes to administer
• Surgeries are becoming less disfiguring. Breast reconstruction and breast conservation are both practical and efficient solutions. Now, radiotherapy may be administered with more precision and in less time
• 30 breast cancer medicines received FDA approval in just ten years, from 2010 to 2020
• Early identification of breast cancer is improved through screening.
• Mammography screening is still crucial and relevant in the age of precision medicine

All these are encouraging developments for breast cancer patients and doctors involved in their treatment. HER2 amplification previously denoted an aggressive disease linked to a higher risk of mortality and recurrence. Nevertheless, improved knowledge of the molecular processes underlying the pathogenesis of HER2-positive breast cancer has led to the development of therapeutic alternatives to improve the prognosis for many women. The prognosis of HER2-positive breast cancer will continue to be improved with the help of new treatment options. The field is ever evolving, adding not only years to life of breast cancer patients, but also life to their remaining years. These advancements raise the prospect of a better tomorrow for cancer patients. Anything is possible once you decide to choose hope. Choose hope over fear!

The author is a MD (AIIMS), DM (AIIMS), Commonwealth Scholar (UK), Senior Director of Medical Oncology Medanta The Medicity, Gurugram. Views expressed are personal.

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