Review of the status of neoadjuvant therapy in HER2-positive breast cancer

Gavin P Dowling; Stephen Keelan; Sinead Toomey; Gordon R Daly; Bryan T Hennessy; Arnold D K Hill

doi:10.3389/fonc.2023.1066007

Review of the status of neoadjuvant therapy in HER2-positive breast cancer

Front Oncol. 2023 Jan 30:13:1066007. doi: 10.3389/fonc.2023.1066007. eCollection 2023.

Authors

Gavin P Dowling^{1

2

3}, Stephen Keelan^{2

3}, Sinead Toomey¹, Gordon R Daly^{2

3}, Bryan T Hennessy¹, Arnold D K Hill^{2

3}

Affiliations

¹ Medical Oncology Lab, Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
² The Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland.
³ The Department of Surgery, Beaumont Hospital, Dublin, Ireland.

Abstract

Purpose: The development of human epidermal growth factor receptor 2 (HER2)-directed therapies has revolutionized the treatment of HER2-positive breast cancer. The aim of this article is to review the continually evolving treatment strategies in the neoadjuvant setting of HER2-positive breast cancer, as well as the current challenges and future perspectives.

Methods: Searches were undertaken on PubMed and Clinicaltrials.gov for relevant publications and trials.

Findings: The current standard of care in high-risk HER2-positive breast cancer is to combine chemotherapy with dual anti-HER2 therapy, for a synergistic anti-tumor effect. We discuss the pivotal trials which led to the adoption of this approach, as well as the benefit of these neoadjuvant strategies for guiding appropriate adjuvant therapy. De-escalation strategies are currently being investigated to avoid over treatment, and aim to safely reduce chemotherapy, while optimizing HER2-targeted therapies. The development and validation of a reliable biomarker is essential to enable these de-escalation strategies and personalization of treatment. In addition, promising novel therapies are currently being explored to further improve outcomes in HER2-positive breast cancer.

Keywords: HER2 (human epidermal growth factor 2); antibody-drug-conjugates; biomarker; breast cancer; neoadjuvant therapy; targeted therapy.

Publication types

Review