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He X, Xu X, Zhu G, Ye H. Circulating uPA as a potential prognostic biomarker for resectable esophageal squamous cell carcinoma. Medicine (Baltimore) 2019; 98:e14717. [PMID: 30817615 PMCID: PMC6831346 DOI: 10.1097/md.0000000000014717] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Previous research showed that the 4 genes of matrix metallopeptidase 9 (MMP9), cyto-keratin 20 (CK20), cyto-keratin 19 (CK19) and urokinase type plasminogen activator (uPA) are detectable in the peripheral blood. All the 4 genes are related to tumor invasion and metastasis. However, whether their expression is associated with clinicopathologic factors and the prognosis of patients with esophageal squamous cell carcinoma (ESCC) is still confused. Expression levels of MMP9, CK20, CK19, and uPA were evaluated by quantificational real-time polymerase chain reaction (qRT-PCR) in peripheral blood of 205 ESCC patients who received radical resection. The cut-off value was 1000 copy numbers. Their impacts on clinicopathologic factors and survival were investigated. The uPA expression positively correlated with gender (P = .046) and tumor size (P = .046). Meanwhile, CK19 expression positively correlated with tumor size (P = .029), vascular invasion (P = .024), and CK20 expression positively correlated with tumor size (P = .035) and degrees of differentiation (P = .032). Moreover, the overexpression of MMP9 has a correlation with postoperative radiotherapy (P = .041) and chemotherapy (P = .012). Among the 4 genes, only uPA is a prognostic indicator for disease-free survival and overall survival both in univariate analysis and multivariate analysis (P = .015). This study suggests that circulating uPA mRNA in peripheral blood can serve as a potential unfavorable prognosis biomarker in ESCC. Further perspective, multi-center and large-scale study is still needed.
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Affiliation(s)
- Xiao He
- Department of Radiotherapy, Lishui People's Hospital, Lishui
| | - Xiaoling Xu
- Key Laboratory of Diagnosis and Treatment Technology for Thoracic Cancer, Zhejiang Cancer Research Institute, Zhejiang Cancer Hospital, Zhejiang Cancer Center, Hangzhou, People's Republic of China
| | - Guanxia Zhu
- Key Laboratory of Diagnosis and Treatment Technology for Thoracic Cancer, Zhejiang Cancer Research Institute, Zhejiang Cancer Hospital, Zhejiang Cancer Center, Hangzhou, People's Republic of China
| | - Hong Ye
- Department of Radiotherapy, Lishui People's Hospital, Lishui
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Arkadius P, Volkmar M, Jens H, Wolfgang J, Tanja F. Circulating tumor cells in metastatic breast cancer: clinical relevance and biological potential. Curr Opin Obstet Gynecol 2019; 31:76-81. [PMID: 30540583 DOI: 10.1097/gco.0000000000000514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW The possibility of tumor dissemination through the blood system has been known for years. Circulating tumor cells (CTCs) are detectable in the peripheral blood of patients with early as well as metastatic breast cancer. The prognostic relevance of this biomarker has already been described. By the use of repeated blood sampling along the course of disease, CTCs can be monitored in terms of a regular 'liquid biopsy'. This review aims to summarize recent research findings and actual ongoing clinical studies to demonstrate the actual and future relevance of CTCs in daily clinical routine. RECENT FINDINGS Recent research results show that additional molecular analysis of CTCs might be helpful in gaining information about tumor characteristics, tumor heterogeneity and possible therapy resistance. Repetitive invasive core biopsies might be avoided. SUMMARY The assessment of molecular attributes may be indispensable for obtaining an optimized and personalized therapy aiming at extended survival and/or improved quality of life.
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Affiliation(s)
- Polasik Arkadius
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm
| | - Müller Volkmar
- Department of Gynecology, Hamburg-Eppendorf University Medical Center, Hamburg
| | - Huober Jens
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm
| | - Janni Wolfgang
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm
| | - Fehm Tanja
- Department of Gynecology and Obstetrics, Düsseldorf University Hospital, Düsseldorf, Germany
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Gogia A, Nigade J, Desai C, Govind BK, Deshmukh C, Swarup B. Trastuzumab Emtansine: Antibody-drug Conjugate in Treatment of Human Epidermal Growth Factor Receptor-2-Positive Metastatic Breast Cancer. Indian J Med Paediatr Oncol 2018. [DOI: 10.4103/ijmpo.ijmpo_53_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
AbstractThe human epidermal growth factor receptor-2 (HER2)-targeted therapies have improved clinical outcomes for patients at any stage of HER2-positive breast cancer (BC). Trastuzumab, a monoclonal antibody that targets the HER2 receptor on BC cells, showed improved survival in metastatic BC (MBC). However, resistance to therapy arises in the majority of patients with advanced disease. Antibody–drug conjugate (ADC) is a relatively new development to deliver cytotoxic drugs specifically to cancer cells. Trastuzumab emtansine (T-DM1) is a HER2-targeted ADC, composed of trastuzumab, a stable thioether linker, and the potent cytotoxic agent, emtansine (DM1, derivative of maytansine). T-DM1 has been approved for use in patients with MBC who have failed prior therapy with trastuzumab and a taxane. Dose finding Phase I study established the maximum tolerated dose at 3.6 mg/kg every 3 weeks. Phase I and II studies of T-DM1 have shown clinical activity and a favorable safety profile in HER2-positive MBC patients. The Phase III randomized EMILIA and TR3RESA trials demonstrated that T-DM1 significantly improves progression-free and overall survival in pretreated HER2-positive MBC patients. Nausea and fatigue are most commonly reported adverse drug reactions with T-DM1 and cardiac toxicity comparable with standard of care therapies. The drug is well tolerated in most patients, with a predictable pharmacokinetic profile and minimal systemic exposure to free cytotoxic DM1. T-DM1 has emerged as an effective therapeutic option for the management of patients with HER2-positive MBC.
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Affiliation(s)
- Ajay Gogia
- Department of Medical Oncology, Dr. Bhimrao Ramji Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Jagdish Nigade
- Roche Products (India) Pvt Ltd. Bandra Kurla Complex, Bandra (E), Mumbai, Maharashtra, India
| | - Chirag Desai
- Department of Medical Affairs, Hemato-Oncology Clinic, Vedanta Institute of Medical Sciences, Navrangpura, Ahmedabad, Gujarat, India
| | - Babu K Govind
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Chetan Deshmukh
- Department of Oncology, Deenanath Mangeshkar Hospital and Research Center, Erandwane, Pune, Maharashtra, India
| | - Binay Swarup
- Roche Products Pvt Ltd. Bandra Kurla Complex, Bandra (E), Mumbai, Maharashtra, India
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Polasik A, Tzschaschel M, Schochter F, de Gregorio A, Friedl TWP, Rack B, Hartkopf A, Fasching PA, Schneeweiss A, Müller V, Huober J, Janni W, Fehm T. Circulating Tumour Cells, Circulating Tumour DNA and Circulating MicroRNA in Metastatic Breast Carcinoma - What is the Role of Liquid Biopsy in Breast Cancer? Geburtshilfe Frauenheilkd 2017; 77:1291-1298. [PMID: 29269956 PMCID: PMC5734937 DOI: 10.1055/s-0043-122884] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/09/2017] [Accepted: 11/12/2017] [Indexed: 12/21/2022] Open
Abstract
Dissemination of tumour cells and the development of solid metastases occurs via blood vessels and lymphatics. Circulating tumour cells (CTCs) and circulating tumour DNA (ctDNA) can be detected in venous blood in patients with early and metastatic breast cancer, and their prognostic relevance has been demonstrated on numerous occasions. Repeated testing for CTCs and ctDNA, or regular so-called "liquid biopsy", can be performed easily at any stage during the course of disease. Additional molecular analysis allows definition of tumour characteristics and heterogeneity that may be associated with treatment resistance. This in turn makes personalised, targeted treatments possible that may achieve both improved overall survival and quality of life.
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Affiliation(s)
- Arkadius Polasik
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Marie Tzschaschel
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Fabienne Schochter
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Amelie de Gregorio
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Thomas W. P. Friedl
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Brigitte Rack
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Andreas Hartkopf
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Peter A. Fasching
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Volkmar Müller
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Huober
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Wolfgang Janni
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Tanja Fehm
- Klinik für Gynäkologie und Geburtshilfe, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
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Harbeck N, Saupe S, Jäger E, Schmidt M, Kreienberg R, Müller L, Otremba BJ, Waldenmaier D, Dorn J, Warm M, Scholz M, Untch M, de Wit M, Barinoff J, Lück HJ, Harter P, Augustin D, Harnett P, Beckmann MW, Al-Batran SE. A randomized phase III study evaluating pegylated liposomal doxorubicin versus capecitabine as first-line therapy for metastatic breast cancer: results of the PELICAN study. Breast Cancer Res Treat 2016; 161:63-72. [PMID: 27798749 PMCID: PMC5222915 DOI: 10.1007/s10549-016-4033-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 10/19/2016] [Indexed: 12/03/2022]
Abstract
Purpose The PELICAN trial evaluates for the first time efficacy and safety of pegylated liposomal doxorubicin (PLD) versus capecitabine as first-line treatment of metastatic breast cancer (MBC). Methods This randomized, phase III, open-label, multicenter trial enrolled first-line MBC patients who were ineligible for endocrine or trastuzumab therapy. Cumulative adjuvant anthracyclines of 360 mg/m2 doxorubicin or equivalent were allowed. Left ventricular ejection fraction of >50 % was required. Patients received PLD 50 mg/m2 every 28 days or capecitabine 1250 mg/m2 twice daily for 14 days every 21 days. The primary endpoint was time-to-disease progression (TTP). Results 210 patients were randomized (n = 105, PLD and n = 105, capecitabine). Adjuvant anthracyclines were given to 37 % (PLD) and 36 % (capecitabine) of patients. No significant difference was observed in TTP [HR = 1.21 (95 % confidence interval, 0.838–1.750)]. Median TTP was 6.0 months for both PLD and capecitabine. Comparing patients with or without prior anthracyclines, no significant difference in TTP was observed in the PLD arm (log-rank P = 0.64). For PLD versus capecitabine, respectively, overall survival (median, 23.3 months vs. 26.8 months) and time-to-treatment failure (median, 4.6 months vs. 3.7 months) were not statistically significantly different. Compared to PLD, patients on capecitabine experienced more serious adverse events (P = 0.015) and more cardiac events among patients who had prior anthracycline exposure (18 vs. 8 %; P = 0.31). Conclusion Both PLD and capecitabine are effective first-line agents for MBC.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology and CCC of LMU, University of Munich, Munich, Germany.
| | - Steffen Saupe
- Department of Obstetrics and Gynecology, Technical University of Munich, Munich, Germany
| | - Elke Jäger
- Oncology and Hematology, Krankenhaus Nordwest, Frankfurt, Germany
| | - Marcus Schmidt
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Mainz, Germany
| | | | | | | | | | - Julia Dorn
- Department of Obstetrics and Gynecology, Technical University of Munich, Munich, Germany
| | - Mathias Warm
- Brustzentrum, Krankenhaus Köln-Holweide, Cologne, Germany
| | | | | | | | - Jana Barinoff
- Dr.-Horst-Schmidt-Kliniken Wiesbaden, Wiesbaden, Germany
| | | | | | - Doris Augustin
- Klinikum des Landkreises Deggendorf, Deggendorf, Germany
| | - Paul Harnett
- Crown Princess Mary Cancer Centre Westmead, Sydney, Australia
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany
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Impact of guideline-based use of uPA/PAI-1 on patient outcome in intermediate-risk early breast cancer. Breast Cancer Res Treat 2015; 155:109-15. [PMID: 26643086 DOI: 10.1007/s10549-015-3653-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/26/2015] [Indexed: 01/04/2023]
Abstract
The purpose of this study was to evaluate the influence of guideline-based prospective use of uPA/PAI-1 on clinical outcome in an intermediate-risk cohort of breast cancer patients. We analyzed 381 consecutive primary breast cancer patients (2003-2011) at the breast center Ostbayern meeting the following criteria: M0/N0/estrogen receptor (ER)+/G2. Clinical-pathological data, uPA/PAI-1, and follow-up data were collected. Decisions for adjuvant chemotherapy were made upon consideration of prospectively measured uPA/PAI-1. Observed disease-free survival (DFS) and overall survival (OS) were calculated by Kaplan-Meier estimates. Using guideline-based analysis of uPA/PAI-1, treatment with adjuvant chemotherapy was avoided in 86.5 % of patients with low uPA/PAI-1, i.e., 38.8 % of the total patient collective. Median follow-up was 52.5 months. Five-year relapse-free survival in intermediate-risk patients (N0, G2) without chemotherapy was 99 %. Five-year overall survival including all causes of death was 95 %. By using uPA/PAI-1, adjuvant chemotherapy can be avoided in a major part of patients with intermediate-risk breast cancer. Nevertheless, DFS and OS of these patients at 5 years remain excellent. The potential, but hardly measurable, benefit of adjuvant chemotherapy has to be set in contrast with its associated side effects and increased morbidity. Patients with high uPA/PAI-1 show benefit from chemotherapy. In this subgroup, a very good OS was observed as well. These findings strongly support the use of uPA/PAI-1 together with clinic-pathological parameters as an evidence-based, clinically relevant and inexpensive decision tool in the routine of a breast center.
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Maluta S, Kolff MW. Role of Hyperthermia in Breast Cancer Locoregional Recurrence: A Review. Breast Care (Basel) 2015; 10:408-12. [PMID: 26989361 DOI: 10.1159/000440792] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
In patients with locoregional recurrences of breast cancer not suitable for resection, subsequent local control is difficult to maintain in previously irradiated areas when reirradiation alone or reirradiation with chemotherapy is used. Due to the limited number of treatment options there is a high risk of subsequent failure and uncontrollable local disease. In this group of patients, local hyperthermia combined with radiotherapy increases the clinical response and local control, adding limited acute and late toxicity, as has been shown in randomized trials. Hyperthermia is an artificial elevation of tissue temperature (range 40-44°C for 30-60 min). If hyperthermia is applied shortly before or after radiation, the effect of radiation is enhanced by influencing intratumoral hypoxia and by inhibiting sublethal damage repair in the tumor. Moreover, hyperthermia combined with radiation reduces the total dose of radiation needed compared to radiation alone, of which a higher dose is needed to obtain the same effect. Few data are available on the combination of radiotherapy and hyperthermia with chemotherapy, although the results of trimodality treatment consisting of reirradiation and hyperthermia together with liposomal doxorubicin are promising. Therefore, this literature review was performed to provide more comprehensive data on the mechanism and use of hyperthermia in locoregional recurrence of breast cancer.
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Affiliation(s)
- Sergio Maluta
- Department of Hyperthermia, Serena Medical Center, Padova, Italy
| | - Merel Willemijn Kolff
- Department of Radiotherapy and Hyperthermia, Academic Medical Center, Amsterdam, The Netherlands
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Therapeutic intervention based on circulating tumor cell phenotype in metastatic breast cancer: concept of the DETECT study program. Arch Gynecol Obstet 2015; 293:271-81. [DOI: 10.1007/s00404-015-3879-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/26/2015] [Indexed: 12/18/2022]
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Martella F, Bacci C, Giordano C, Montagnani F, Gelain E, Rabatti L, Fioretto L. Eribulin mesylate in advanced breast cancer: retrospective review of a single institute experience. Future Oncol 2015; 11:31-6. [DOI: 10.2217/fon.15.151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: EMA licensed eribulin mesylate in 2011 for women with advanced breast cancer already treated with at least two lines of chemotherapy, including anthracyclines and taxanes. Azienda Sanitaria Firenze experience is reported to assess the efficacy and safety of eribulin in the real-life setting. Patients & methods: Eribulin was infused as per indication. All women treated in the last 2 years were reviewed. Results: A total of 27 women received eribulin. All but one was pretreated with anthracyclines, 97% with taxanes and 87% with capecitabine. Median age was 63 years (range: 27–80). A median of four cycles of eribulin were infused (range: 2–10). Overall response rate was 30% with a 45% of clinical benefit (response plus stable disease for at least 24 weeks). Toxicities have been as expected. Severe toxicities were rare, with one patient experiencing sepsis and 18% developing grade 3 asthenia. Conclusion: Eribulin maintains its activity out of clinical trials, without unexpected toxicities.
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Affiliation(s)
- Francesca Martella
- SOC Oncologia Medica, Dipartimento Oncologico Azienda Sanitaria Firenze, Istituto Toscano Tumori, Piazza Santa Maria Nuova 1, 50100, Firenze, Italia
| | - Carlotta Bacci
- SOC Oncologia Medica, Dipartimento Oncologico Azienda Sanitaria Firenze, Istituto Toscano Tumori, Piazza Santa Maria Nuova 1, 50100, Firenze, Italia
| | - Clara Giordano
- SOC Oncologia Medica, Dipartimento Oncologico Azienda Sanitaria Firenze, Istituto Toscano Tumori, Piazza Santa Maria Nuova 1, 50100, Firenze, Italia
| | - Francesco Montagnani
- SOC Oncologia Medica, Dipartimento Oncologico Azienda Sanitaria Firenze, Istituto Toscano Tumori, Piazza Santa Maria Nuova 1, 50100, Firenze, Italia
| | - Elena Gelain
- Data Manager Clinical Research Group Dipartimento Oncologico Azienda Sanitaria Firenze, Presso Ospedale Santa Maria Annunziata, Via dell'Antella 58, Bagno a Ripoli, Firenze, Italia
| | - Loredana Rabatti
- Dipartimento del Farmaco Azienda Sanitaria Firenze, Farmacia ospedaliera Ospedale Santa Maria Annunziata, Via dell'Antella 58, Bagno a Ripoli, Firenze, Italia
| | - Luisa Fioretto
- SOC Oncologia Medica, Dipartimento Oncologico Azienda Sanitaria Firenze, Istituto Toscano Tumori, Piazza Santa Maria Nuova 1, 50100, Firenze, Italia
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Schramm A, De Gregorio N, Widschwendter P, Fink V, Huober J. Targeted Therapies in HER2-Positive Breast Cancer - a Systematic Review. Breast Care (Basel) 2015; 10:173-8. [PMID: 26557822 DOI: 10.1159/000431029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
About 20% of all breast cancer patients have a human epidermal growth factor receptor 2 (HER2)-positive breast tumor. This entity underwent an impressive change in prognosis, with notable improvement of progression-free survival and overall survival. Due to more aggressive tumors and no specific therapy, HER2 overexpression was historically seen as a negative prognostic marker, with worse prognosis and increased risk of recurrent disease. Trastuzumab, the first anti-HER2 antibody, revolutionized the systemic therapy options in HER2-positive breast cancer and initiated several targeted therapies and more personalized treatment strategies. Over the years, multiple HER2-targeting drugs stepped into clinical practice, for the curative as well as the metastatic situation. This review summarizes the targeted treatment options in HER2-positive breast cancer and their current impact in the clinical routine. Results of the most outstanding trials in HER2-targeted therapies and important ongoing trials are subsequently described for an up-to-date overview.
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Affiliation(s)
- Amelie Schramm
- Department of Gynecology and Obstetrics, University Hospital Ulm, Germany
| | | | | | - Visnja Fink
- Department of Gynecology and Obstetrics, University Hospital Ulm, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, University Hospital Ulm, Germany
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