Controversies of radiotherapy in human epidermal growth factor receptor (HER)-2 positive breast cancer patients
Language English Country Czech Republic Media print-electronic
Document type Journal Article, Review
PubMed
33542544
DOI
10.5507/bp.2021.007
Knihovny.cz E-resources
- Keywords
- HER-2, breast cancer, locoregional recurrence, radiation therapy, trastuzumab,
- MeSH
- Humans MeSH
- Breast Neoplasms drug therapy metabolism radiotherapy MeSH
- Antineoplastic Agents, Immunological therapeutic use MeSH
- Receptor, ErbB-2 biosynthesis MeSH
- Trastuzumab therapeutic use MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
- Names of Substances
- ERBB2 protein, human MeSH Browser
- Antineoplastic Agents, Immunological MeSH
- Receptor, ErbB-2 MeSH
- Trastuzumab MeSH
Tumor biology plays a crucial role in the systemic treatment, specifically in HER2-positive tumors. Distinct biological behavior of breast cancer subtypes is associated with different rates of locoregional recurrence (LRR). HER2- positive breast cancer patients treated with surgery in combination with radiation, without trastuzumab have poor outcome, including high LRR. The efficacy of radiotherapy in HER-2-positive breast cancer appears to be associated with the expression of estrogen receptors. In patients with HER-2-positive breast cancer, studies conducted before the introduction of trastuzumab indicated higher benefit of adjuvant radiation in patients with hormone receptor-positive tumors compared to patients with tumors not expressing hormone receptors. The introduction of agents targeting HER-2 has transformed the management of these patients, resulting in improved outcomes. The data of clinical studies show that the administration of trastuzumab as part of a multimodality approach (with radiation based on standard guidelines) results in improved outcomes, including lower locoregional recurrence. The risk of cardiac toxicity associated with radiation to the heart and administration of potential cardiotoxic trastuzumab is not clear. In patients treated concomitantly with regional lymph node irradiation and anti-HER-2 agents after prior anthracycline-based chemotherapy minimizing the dose to the myocardium, e.g. respiratory gating or proton beam radiotherapy, have been suggested.
Department of Oncology 1st Faculty of Medicine Charles University Prague Czech Republic
Department of Oncology and Radiotherapy University Hospital Hradec Kralove Czech Republic
Faculty of Health Studies Pardubice University Pardubice Czech Republic
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