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Management of small HER2 overexpressing tumours

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Abstract

Overexpression of the human epidermal growth factor receptor 2 (HER2) is found in 10–20 % of breast cancers and is associated with a worse prognosis. Several large studies have established the addition of trastuzumab to chemotherapy as the gold standard in early breast cancer that overexpresses HER2. Little is known about the role of such adjuvant treatment in node-negative subcentimeter tumours (‘small tumours’, pT1a/b) because these patients were generally excluded from the pivotal trials. Only the BCIRG006 study published in 2011 included such tumours if high-risk features were present. Here we review the literature of small HER2-positive tumours and present a meta-analysis of retrospective studies confirming a worse outcome in terms of disease-free survival (hazard ratio 2.6, p < 0.001) and a trend for higher odds of distant recurrence at 5 years (odds ratio [OR] 2.51, p = 0.11). We discuss these findings in the light of the increased risk of grade 3 and 4 cardiac toxicity (OR 7.6, p < 0.001) and other adverse events associated with the use of trastuzumab. Such treatment may well be a valuable option in selected patients with high-risk features but physicians should exercise caution given the small absolute benefits of adjuvant chemotherapy and trastuzumab for patients with small HER2-overexpressing tumours.

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Conflict of interest

Philippe Bedard declares research funding from Roche. Eitan Amir declares an advisory role with Roche. The other authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Medical Oncology and Hematology, Princess Margaret Hospital, Department of Medicine, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada

    Arnoud Templeton, Alberto Ocaña, Francisco Vera-Badillo, Lindsay Carlsson, Philippe Bedard & Eitan Amir

  2. Department of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia

    Boštjan Šeruga

Authors
  1. Arnoud Templeton
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  2. Alberto Ocaña
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  3. Boštjan Šeruga
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  4. Francisco Vera-Badillo
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  5. Lindsay Carlsson
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  6. Philippe Bedard
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  7. Eitan Amir
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Correspondence to Eitan Amir.

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Templeton, A., Ocaña, A., Šeruga, B. et al. Management of small HER2 overexpressing tumours. Breast Cancer Res Treat 136, 289–293 (2012). https://doi.org/10.1007/s10549-012-2236-9

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  • DOI: https://doi.org/10.1007/s10549-012-2236-9

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