Recent treatment advances in HER2-positive metastatic breast cancer: a clinical approach

Abstract

The use of targeted therapy directed against HER2 is currently the standard of care in patients with metastatic HER2-positive breast cancer. The combination of trastuzumab with a taxane as first-line treatment in HER2-positive metastatic breast cancer patients is the most common therapeutic approach in this population. The combination of trastuzumab with other chemotherapeutic agents, including vinorelbine and capecitabine; and hormonal therapy agents, such as aromatase inhibitors, have also demonstrated significant activity, and may be considered as an option for selected patients. Recently, the addition of pertuzumab to trastuzumab and docetaxel in first-line therapy has demonstrated an increased progression-free survival in HER2-positive metastatic breast cancer patients. Novel strategies against HER2 in first-line treatment or after progression include HER tyrosine kinase inhibitors such as lapatinib in combination with either chemotherapy, aromatase inhibitors or trastuzumab. An increasing list of new compounds are currently under investigation, such as trastuzumab–emtansine, afatinib, everolimus and antiangiogenic agents, among others. This review discusses potential therapeutic approaches in the first-line setting and after progression beyond trastuzumab in metastatic breast cancer HER2-positive tumors based on the latest evidence.