Help the development of the site, sharing the article with friends!

HER2 positive breast cancer is a particularly aggressive form of cancer - it grows rapidly and is more likely to metastasize to the lymph nodes. That is why the detection of the tumor at an early stage is so important - then the treatment will bring the best benefits, it is even possible to completely cure the tumor.

HER2 positive breast canceris an aggressive form of cancer - it is diagnosed in 18-20 percent of all patients who are diagnosed with breast cancer every year. At the same time, it should be remembered that, while on the one hand HER2 positive breast cancer grows quickly and metastasizes more often, on the other hand - it responds well to targeted therapy, i.e. a therapy matched to the cancer subtype, which makes it the most effective for the patient.

- We can cure HER2 positive breast cancer, but the condition is to detect it as early as possible - says Dr. n. med. prof. extra WIM Renata Duchnowska, Head of the Oncology Clinic of the Military Medical Institute - It must be remembered, however, that HER2-positive breast cancer is characterized by high dynamics of development, therefore, in order to detect it at an early stage, it is necessary for the woman to undergo regular preventive examinations.

What is the HER2 receptor?

HER2 receptorbelongs to the HER family, which consists of four receptors: HER1, HER2, HER3, and HER4, each with a different function. HER2 is a receptor protein that is involved in transmitting signals to cells to control their growth and function.

The presence of the HER2 protein is associated with more aggressive tumor growth. When it is in excess, it is referred to as HER2 positive breast cancer. If this receptor is absent, it is a HER2 negative tumor.

- What drives a HER2 positive tumor is an excess of these receptors. The more of them appear on the surface of neoplastic cells, the easier they divide and the more resistant to various methods of treatment - says Prof. dr hab. n. med. Tadeusz Pieńkowski, Head of the Oncology and Hematology Clinic of the CMKP at the Hospital of the Ministry of Interior and Administration in Warsaw - Due to this high growth dynamics in women with HER2-positive breast cancer, metastases appear faster than in the case of other cancers.

This is why until recently, only 10 years ago, this subtype was considered the most aggressive form of breast cancer. Thanks nowby advances in medicine, patients can live significantly longer, disease-free, cancer-free, and in some cases even cured of breast cancer.

What is HER2 Positive Early Breast Cancer?

There are three stages in the development of any cancer, including HER2 positive cancer:

  • early
  • locally advanced
  • advanced

Early breast cancer is defined as 0, I, or II. The tumor in these stages can vary in size.

Stage 0 is a pre-invasive form. In stage I, the tumor may be no more than 2 cm in diameter, and the lymph nodes do not have metastases, or the tumor may be up to 2 cm in diameter with the presence of micrometastases in the nearest axillary lymph nodes.

In stage II, the tumor may be absent or larger than 5 cm, with or without lymph node involvement.

Early breast cancer is limited to the breast gland and the nearest lymph nodes. There are no metastases to distant organs, and it does not infiltrate the skin or the chest.

HER2 positive early breast cancer: treatment

The first breakthrough in the treatment of breast cancer was the discovery about 20 years ago of targeted therapy that blocks the HER2 receptor, eliminating its negative impact on the development of breast cancer. Currently, this treatment is a standard - it significantly extends the survival of patients and the time without disease recurrence.

Recently, a new therapeutic option has appeared for patients with early HER2-positive breast cancer - a second is added to the already known drug. Thanks to this connection, the so-calleddouble blockade of the aggressive HER2 receptorwhich makes the therapy even more effective.

Women with early HER2 positive breast cancer without positive estrogen receptors, progesterone receptors (so-called HER2-positive non-luminal breast cancer) or with HER2-positive hormone-dependent (luminal) breast cancer, but with metastases to the axillary lymph nodes. Such sick belong to the so-called high-risk groups.

Treatment options for patients with HER2-positive breast cancer are defined by the drug program B.09 in force in Poland. As part of this program, therapy with one drug that blocks the HER2 receptor is available for patients:

  • Option I - in the first stage of treatment, patients receive 4 cycles of chemotherapy containing anthracyclines (a group of antibiotics used as anti-cancer drugs), after which they are qualified for treatment with taxanes and a biological drug that blocks the HER2 receptor
  • option II - application of treatment without anthracyclines; from the very beginning, patients receive therapy with targeted anti-HER2 therapy and two cytostatics (i.e. drugs that are toxic to cancer cells that are rapidly dividing)

In most European countries and the United States, international guidelines recommend that high-risk patients with early HER2 positive breast cancer are treated with two HER2-blockers, not one.

In Poland, this so-called double blockade is reimbursed only for patients with disseminated neoplastic process, when the patient has little chance of recovery.

Patients with early breast cancer do not have access to it, because the drug program does not provide for the use of a combination of two anti-HER2 drugs at this stage, i.e. in the so-called preoperative (neoadjuvant) treatment and adjuvant treatment after surgery (adjuvant).

What is a complete pathological response?

The pre-operative therapy of breast cancer is about obtaining the so-called a complete pathomorphological response (pCR - from the English Pathological Complete Response), which consists in the fact that in the histopathological examination of the removed breast or its fragment after the end of chemotherapy, there will be no cancer cells at all - which means that the tumor has been completely eliminated.

Patients who achieve a complete pathomorphological response have a better prognosis and a greater chance that breast cancer will not recur.

After the implementation of double blockade, the percentage of patients achieving pCR increases by even 15-30% compared to the so-called single lock. Patients from risk groups respond particularly well to treatment - with lymph nodes and negative hormone receptor status, i.e. those with a serious prognosis.

Use of "double blocking" in Poland

As early as 2016, the results of the study were published, which showed that the use of the so-called "Double blocking" in HER2 positive breast cancer may improve treatment outcomes for early breast cancer.

Unfortunately, this type of therapy is not reimbursed in Poland in early breast cancer, when the patient has a chance to cure the cancer. Administering a double blockade reduces the size of the tumor even before the operation, so that, for example, the indication for mastectomy can be changed to a breast-conserving operation, which is of colossal importance for a woman. Additionally, preoperative treatment allows the physician to early assess the response to treatment.

- Early treatment before disease spreadsprevent its recurrence and potential progression to an incurable stage. In addition, in the early stage, the chances of complete recovery are the greatest, such patients should have access to the most effective therapeutic options, because it pays off from an economic point of view. Also, taking into account indirect costs, we must remember that a cured patient does not quit her job and do not require care. Effective therapy also reduces the negative mental consequences of cancer for patients and their families, says Krystyna Wechmann, president of the Federation of Amazonian Associations.

Help the development of the site, sharing the article with friends!

Category:

Oncology