Moffitt’s Approach To Treating Her2 Positive Breast Cancer
The Don & Erika Wallace Comprehensive Breast Program at Moffitt Cancer Center provides comprehensive treatment and supportive care for patients with HER2 positive breast cancer. Our patients benefit from the expertise of a multispecialty team comprising:
- Medical oncologists
- Plastic surgeons
- Fertility preservation specialists
Together, our cancer experts will ensure each patients treatment plan addresses her unique needs and provides her with the best chance of achieving a positive outcome and quality of life. We offer many treatments that specifically target the HER2 protein, as well as other common breast cancer treatments such as chemotherapy.
For early-stage HER2 positive breast cancer, a surgeon may resect the tumor as primary treatment. A lumpectomy or mastectomy may be used to remove the tumor. Every patient and cancer is unique, however, which is why every patient at Moffitt receives an individualized treatment plan. With that said, treatment for HER2 positive breast cancer may take a similar approach as HER2 negative breast cancer, but include the use of HER2-targeted therapies.
As a National Cancer Institute-designated Comprehensive Cancer Center, Moffitt is committed to advancing research and treatment for HER2 positive breast cancer. We spearhead an ambitious clinical trials program, where eligible patients may have the opportunity to benefit from the latest advancements in treatment before they are made available elsewhere.
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Side Effects Of Herceptin
Herceptin often causes side effects, although many of these will become less severe over time.
The following side effects are experienced by around 1 in 10 people:
- a reaction to the medicine, such as chills, a high temperature, swelling of the face and lips, headache, hot flushes, feeling sick, wheezing and breathlessness
- tiredness and difficulty sleeping
Cancer Research UK also has more information about the common side effects of herceptin.
Tell your doctor if you have particularly troublesome side effects, as there may be medicines available to treat them.
There Are Two Ways To Measure The Her
The most common way to measure the HER-2 status of a potential breast cancer tumor is through an immunohistochemistry test. This will likely be part of an overall histological/pathological evaluation of the tumor.
Various tumor markers, including the HER-2 status indicators, give the pathologist a characterization of the tumor. This helps to predict the future behavior and probable responses, of the tumor to different types of treatments.
The immunohistochemistry test of the HER-2 status measures the over-expression of a particular protein and is typically given a score of 0 to +3.
The pathologist actually counts the number of receptors on the surface of the cancer cells. Indeed, the pathologist can see the cells microscopically because they are receptive to certain protein-based dyes and change color.
Scores of 0 and +1 are indicative of a negative status , whilst +2 and +3 are HER-2 positive . There is no in-between state.
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M Categories For Breast Cancer
M followed by a 0 or 1 indicates whether the cancer has spread to distant organs — for example, the lungs, liver, or bones.
M0: No distant spread is found on x-rays or by physical exam.
cM0: Small numbers of cancer cells are found in blood or bone marrow , or tiny areas of cancer spread are found in lymph nodes away from the underarm, collarbone, or internal mammary areas.
M1: Cancer has spread to distant organs as seen on imaging tests or by physical exam, and/or a biopsy of one of these areas proves cancer has spread and is larger than 0.2mm.
Risk Of Recurrence: Early And Late
Research has shown the HER2-positive early breast cancers are two to five times more likely to recur than HER2-negative tumors. Even very small HER2-positive tumors with negative lymph nodes have a much higher risk of recurrence relative to tumors that are HER2-negative. Treatment with Herceptin can cut this risk by half.
The pattern of breast cancer recurrence may also differ. Small tumors are also more likely to have a metastatic recurrence if they are HER2-positive.
Despite the fact that HER2-positive and estrogen receptor-negative tuors are more likely to recur early on than estrogen receptor-positive and HER2-negative cancers, late recurrences are much less common.
With estrogen receptor positive breast cancers, the cancer is more likely to recur after five years than in the first five years, and the risk of recurrence remains steady each year for at least 20 years following the diagnosis. In contrast, those who have HER2 positive tumors and reach their five-year mark are much more likely to be “in the clear” and remain recurrence free.
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Are A Woman Who Could Become Pregnant Or May Be Pregnant
HERCEPTIN HYLECTA may result in the death of an unborn baby or birth defects. Contraception should be used while receiving HERCEPTIN HYLECTA and for 7 months after your last dose of HERCEPTIN HYLECTA. If you are or become pregnant while receiving HERCEPTIN HYLECTA or within 7 months after your last dose of HERCEPTIN HYLECTA, you are encouraged to report HERCEPTIN HYLECTA exposure to Genentech at 18888352555.
Some Proteins Make Breast Tumors More Receptive To Certain Hormones
Sometimes medics use the phrase hormone receptor status along with terms like protein status and HER-2 status. These are all related terms because the presence of certain proteins is what makes a tumor more receptive to certain hormones.
Some hormones affect growth rates, such as the hormones attracted by HER-2 proteins. However, other hormones might suppress growth or actually aid with healing and blood flow.
The hormone receptor status of a tumor is a composite of all the different proteins that might influence the behaviour of a particular tumor in a particular patient. So, the HER-2 status is a small subset of the overall hormonal picture, that specifically rates to the probable growth rate of the new cancer cells.
HER-2 gene amplification in breast cancer:-
- reduces apoptosis
- means more progressive regional and distant metastases.
So, breast cancers presenting with a higher-than-average or positive HER-2 status will almost certainly be more aggressive.
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What Are The Newest Her2 Positive Breast Cancer Medicines Available
Several medicines have been approved or are under clinical trial as HER2 positive breast cancer targeted therapies.
Here are some of them:
Enhertu 2,3,4
Enhertu is used for the treatment of adult patients with unresectable or metastatic HER2 positive breast cancer who have been treated previously for their metastatic cancer.
It is a combination of an anti-HER2 medicine that has the same basic structure as Herceptin, the chemotherapy medicine topoisomerase I inhibitor, and deruxtecan, a compound that links the other two together. Enhertu was designed to deliver topoisomerase I inhibitor to cancer cells in a targeted way by attaching the topoisomerase I inhibitor to the anti-HER2 medicine, which then carries the chemotherapy to the HER2-positive cancer cells.
On 20 December 2019, the Food and Drug Administration , USA granted Enhertu with an accelerated approval for the treatment of adult patients with unresectable or metastatic HER2 positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting. On 25 March 2020, the Pharmaceuticals and Medical Devices Agency , Japan approved Ehertu for the treatment of patients with HER2 positive unresectable or recurrent breast cancer after prior chemotherapy .
Phesgo 5
Phesgo is combined with intravenous chemotherapy for the treatment of adults with HER2-positive breast cancer that has metastasized, and of adult patients with early HER2-positive breast cancer.
Piqray 6,7
Tukysa
Detecting Breast Cancer With Screening And Awareness
One of the best ways to improve your chances of surviving breast cancer is to be vigilant about getting routine screenings for the disease. The earlier cancer is found, the better the outlook. According to the ACS, screening reduces breast cancer deaths by 20%. The ACS says that women at average risk for breast cancer should have the option of starting annual screening mammograms between ages 40 to 44 years, while women ages 45 to 54 years should have annual mammograms. Starting at age 55, women should have the option of receiving a mammogram every year or every two years, the ACS says.
Dr. Cairoli points out that younger women who arent covered by screening recommendations should not assume theyre not susceptible to breast cancer. Unfortunately, theres no such thing as too young. Breast cancers can occur in patients even in their 20s. He recommends that all women, especially those not yet of screening age, perform monthly breast self-examinations.Monthly breast self-exams havent been shown to improve outcomes for the population at large, but by knowing your body youll be able to alert your physician if you notice a change, Dr. Cairoli says. And if you do find something unusual, he adds, insist on a physical examination or screening even if your doctor tries to tell you youre too young for breast cancer.
Breast cancer symptoms to be alert for include:
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To learn more about RCCA, call 844-928-0089 or visit RCCA.com.
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Possible Serious Side Effects With Herceptin Hylecta
Not all people have serious side effects, but side effects with HERCEPTIN HYLECTA therapy are common.
Although some people may have a life-threatening side effect, most do not.
Your doctor will stop treatment if any serious side effects occur.
HERCEPTIN HYLECTA is not for everyone. Be sure to contact your doctor if you are experiencing any of the following:
Can Other Drugs Interfere With Hormone Therapy
Certain drugs, including several commonly prescribed antidepressants , inhibit an enzyme called CYP2D6. This enzyme plays a critical role in the body’s use of tamoxifen because CYP2D6 metabolizes, or breaks down, tamoxifen into molecules, or metabolites, that are much more active than tamoxifen itself.
The possibility that SSRIs might, by inhibiting CYP2D6, slow the metabolism of tamoxifen and reduce its effectiveness is a concern given that as many as one-fourth of breast cancer patients experience clinical depression and may be treated with SSRIs. In addition, SSRIs are sometimes used to treat hot flashes caused by hormone therapy.
Many experts suggest that patients who are taking antidepressants along with tamoxifen should discuss treatment options with their doctors, such as switching from an SSRI that is a potent inhibitor of CYP2D6, such as paroxetine hydrochloride , to one that is a weaker inhibitor, such as sertraline or citalopram , or to an antidepressant that does not inhibit CYP2D6, such as venlafaxine . Or doctors may suggest that their postmenopausal patients take an aromatase inhibitor instead of tamoxifen.
Other medications that inhibit CYP2D6 include the following:
- Quinidine, which is used to treat abnormal heart rhythms
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The Following Statistics Are A Little Old Now They Are Much Better
There are of course many factors that contribute to the survival of breast cancer. However, some older studies show that only about 60%of patients with HER-2 positive status invasive breast cancer are disease free after 10 years.
In addition, about 65% survive overall .
And, a greater number of HER-2 positive patients succumb to the illness during the first five years than those who are negative for HER-2 overexpression.
At the same time, all other factors assumed to be equal, patients with negative HER-2 status tumors tend to be disease free at a rate of 75% over 10 years and have a slightly higher overall survival rate.
From this, we can informally estimate that women with breast cancer which overexpresses HER-2 are about 10% more likely to have significant difficulties and ultimately succumb to the disease within the first five years, than those who do not.
Because some of the Incidence and Prognosis rates are a little old now check out our brand new Index of Posts on Survival Rates.
Targeted Therapy: Herceptin Biosimilars
Generic drugs donât exist for brand-name biologics. Biologics are made of large, complex molecules and produced — thanks to the magic of biotechnology — in a living system, such as an animal or plant cell. You canât replicate that.
But you can create a similar version. These drugs are called biosimilars. They have âno clinically meaningful differencesâ in terms of safety, purity, or potency.
Trastuzumab and hyaluronidase is another type of trastuzumab treatment that is injected underneath the skin.
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N Categories For Breast Cancer
N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are involved.
Lymph node staging for breast cancer is based on how the nodes look under the microscope, and has changed as technology has gotten better. Newer methods have made it possible to find smaller and smaller groups of cancer cells, but experts haven’t been sure how much these tiny deposits of cancer cells influence outlook.
Its not yet clear how much cancer in the lymph node is needed to see a change in outlook or treatment. This is still being studied, but for now, a deposit of cancer cells must contain at least 200 cells or be at least 0.2 mm across for it to change the N stage. An area of cancer spread that is smaller than 0.2 mm doesn’t change the stage, but is recorded with abbreviations that indicate the type of special test used to find the spread.
If the area of cancer spread is at least 0.2 mm , but still not larger than 2 mm, it is called a micrometastasis . Micrometastases are counted only if there aren’t any larger areas of cancer spread. Areas of cancer spread larger than 2 mm are known to influence outlook and do change the N stage. These larger areas are sometimes called macrometastases, but are more often just called metastases.
NX: Nearby lymph nodes cannot be assessed .
N0: Cancer has not spread to nearby lymph nodes.
N1c: Both N1a and N1b apply.
N3: Any of the following:
N3a: either:
N3b: either:
Horizontal Inhibition Of The Her2 Pathway
The first randomized trial investigating neoadjuvant trastuzumab in addition to chemotherapy showed a statistically significant improvement in total pCR , a 5-year event-free survival of 58 vs. 43% , and a nonsignificant improvement in OS . Similarly, in the GeparQuattro study , the pCR rate was 31.7% with trastuzumab and 15.7% in the reference group . After showing a significant impact on outcomes in a metastatic setting, logically, pertuzumab has been investigated in the neoadjuvant environment .
The NeoSphere trial first showed that dual horizontal blockade with pertuzumab and trastuzumab in combination with chemotherapy resulted in a significantly improved pCR rate in the breast in comparison with trastuzumab/chemotherapy combination without additional cardiotoxicity . In the 5-year follow-up data, patients who achieved pCR had a longer progression-free survival compared to patients who did not .
The TRYPHAENA trial was designed to evaluate cardiac safety in patients treated with neoadjuvant antracycline-containing and antracycline-free chemotherapy regimens with trastuzumab and pertuzumab . The combination of anti-HER2 antibodies was generally well tolerated, regardless of whether it was given sequentially or concomitantly with anthracycline-based or combined with carboplatin-based chemotherapy. The rate of achieved pCR ranges from 57.3 to 66.2% .
Table 1.
Neoadjuvant trials with a horizontal HER2 pathway blockade strategy
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Who May Not Be Able To Have Herceptin
Herceptin should not be used to treat people with breast, oesophageal or stomach cancer that is not HER2 positive.
It may also not be suitable if:
- you have a pre-existing heart condition, such as heart failure, severe angina or a problem with your heart valves
- you have poorly controlled high blood pressure
- you’re pregnant
- you’re breastfeeding
Avoid becoming pregnant while taking herceptin and for at least 7 months after treatment stops, as it could harm your developing baby.
Also avoid breastfeeding until at least 7 months after treatment stops, as the medicine can enter breast milk and may be harmful for babies.
Possible Serious Side Effects With Herceptin
Not all people have serious side effects, but side effects with HERCEPTIN therapy are common.
Although some people may have a life-threatening side effect, most do not.
Your doctor will stop treatment if any serious side effects occur.
HERCEPTIN is not for everyone. Be sure to contact your doctor if you are experiencing any of the following:HEART PROBLEMS
These include heart problemssuch as congestive heart failure or reduced heart functionwith or without symptoms. The risk for and seriousness of these heart problems were highest in people who received both HERCEPTIN and a certain type of chemotherapy . In a study of adjuvant breast cancer, one patient died of significantly weakened heart muscle. Your doctor will check for signs of heart problems before, during, and after treatment with HERCEPTIN.INFUSION REACTIONS, including:
- Feeling sick to your stomach
- Throwing up
- Pain
- Headache
These signs usually happen within 24 hours after receiving HERCEPTIN.Be sure to contact your doctor if you: Are a woman who could become pregnant, or may be pregnant
HERCEPTIN may result in the death of an unborn baby or birth defects. Contraception should be used while receiving HERCEPTIN and for 7 months after your last dose of HERCEPTIN. If you are or become pregnant while receiving HERCEPTIN or within 7 months after your last dose of HERCEPTIN, you should immediately report HERCEPTIN exposure to Genentech at 1-888-835-2555.
Have any signs of SEVERE LUNG PROBLEMS, including:
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Treatment Options For Her2 Positive Breast Cancer Tumors
Treating doctors will usually offer women with HER-2 positive breast treatment with Trastuzumab .
Indeed, this is the only therapy that the US Food and Drug Administration approvesfor women with breast cancer tumors over-expressing HER-2 proteins.
It is often the case that women with HER2 breast cancer tumors do not respond to Tamoxifen therapy.
But, the use of trastuzumab in combination with chemotherapy has led to longer survival rates for women with metastatic HER-2 positive breast carcinomas.
The addition of Herceptin when HER-2 is positive gives an amazing boost to the response and cure rates.
Targeted Therapy For Breast Cancer
Targeted therapy is usually used to treat breast cancer. It uses drugs to target specific molecules on cancer cells or inside them. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells and limit harm to normal cells. Targeted therapy may also be called molecular targeted therapy.
You may have targeted therapy to:
- stop breast cancer cells from growing and spreading
- lower the risk that the cancer will come back
- treat breast cancer that has spread to other parts of the body and that no longer responds to other breast cancer treatments
Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of targeted therapy. You may also receive other treatments.
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