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Maintenance Therapy in HER2-Negative Metastatic Breast Cancer: A New Approach for an Old Concept

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Abstract

The aim of this article is to discuss the role of maintenance therapy with chemotherapy, endocrine therapy, or bevacizumab-based combination therapy in patients with human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer. The optimization of maintenance therapy in patients with HER2-negative metastatic breast cancer must be based on disease profile (tumor subtype and endocrine-sensitive status), the prior use of bevacizumab-containing regimens, and the number of prognostic risk factors. Chemotherapy should be used in patients with triple-negative breast cancer and endocrine-resistant hormone receptor-positive metastatic breast cancer, whereas endocrine therapy is the preferred option for patients with endocrine-sensitive hormone receptor-positive metastatic breast cancer. After first-line bevacizumab plus chemotherapy, bevacizumab may be continued until disease progression or unacceptable toxicity, and endocrine therapy or capecitabine may be added. The goals of maintenance therapy in patients with HER2-negative metastatic breast cancer are to improve and maintain clinical response, increase time to progression, extend overall survival, relieve tumor-related symptoms, and delay the use of aggressive therapies, without compromising quality of life. Maintenance therapy, using chemotherapy, endocrine therapy, and combined therapy with bevacizumab, is a reasonable strategy to achieve these goals in patients with either triple-negative breast cancer or hormone receptor-positive and HER2-negative metastatic breast cancer. Ongoing clinical studies of new molecular-targeted therapies may provide additional pharmacological options for future maintenance strategies in these patients.

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Acknowledgements

The authors thank Dr. Fernando Sánchez Barbero and Irene Perucho on behalf of Springer Healthcare (Madrid, Spain) for their help in the preparation of the manuscript. Sarah Greig, PhD, of Springer Healthcare Communications (Auckland, New Zealand) provided English language editing. This medical writing support was provided by Roche, Spain.

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Authors and Affiliations

  1. Medical Oncology Department, Hospital Universitario 12 de Octubre, Madrid, Spain

    Eva Ciruelos

  2. IOB Institute of Oncology, Quiron University Hospital, Plaza Alfonso Comin 5-7, 08023, Barcelona, Spain

    José Manuel Pérez-García

  3. Instituto Valenciano de Oncología, Valencia, Spain

    Joaquín Gavilá

  4. Roche Farma S.A., Madrid, Spain

    Analía Rodríguez

  5. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, Universidad de Córdoba, Córdoba, Spain

    Juan de la Haba-Rodriguez

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Correspondence to José Manuel Pérez-García.

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Roche provided financial support for the medical writing services.

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Joaquin Gávila has received honoraria from Roche, Novartis, Pfizer, and Celgene; Juan de la Haba, José Manuel Pérez-García, and Joaquín Gavilá have participated as consultants on advisory boards for Roche and Novartis. Analía Rodriguez is an employee of Roche Farma, Spain. Eva Ciruelos has no conflicts of interest that are directly relevant to the content of this article.

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Ciruelos, E., Pérez-García, J.M., Gavilá, J. et al. Maintenance Therapy in HER2-Negative Metastatic Breast Cancer: A New Approach for an Old Concept. Clin Drug Investig 39, 595–606 (2019). https://doi.org/10.1007/s40261-019-00790-9

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