• HER2 Positive Breast Cancer
  • For early stage --> recommend surgery followed by adjuvant chemotherapy with a year of herceptin (trastuzumab)
  • For advanced stage --> recommend neoadjuvant chemotherapy followed by surgery and a year of herceptin
  • Cleopatra showed improved progression-free survival with combination of trastuzumab and pertuzumab
    • Trastuzumab (Herceptin) --> inhibits HER2 receptor to prevent signal transduction
    • Pertuzumab --> inhibits HER2 dimerization; works synergistically with herceptin
  
  

  Posted 04/11/17 07:33:16 AM by Ying Liu

• HER2 Targeted Agents and Cardiotoxicity
  • Incidence is around 0.5-3% of patients treated with trastuzumab (higher if getting an anthracycline)
  • Risk factors include age > 50, obesity and concurrent anthracycline administration. Concurrent radiation therapy does not increase risk
  • Often manifests as a decreased in LVEF, usually asymptomatic but can cause clinical HF
  • Unlike anthracyclines, cardiotoxicity is not related to cumulative dose
  • Reversible with treatment discontinuation and rechallenge is often tolerated after cardiac recovery
  • Mechanism is thought to be more myocyte “stunning” and loss of contractility
  • Data on Pertuzumab is limited but suggests that it may be less cardiotoxic than trastuzumab
  
  

  Posted 04/11/17 07:33:50 AM by Ying Liu

• For further reading...

  Cleopatra Trial
  
  

  Posted 04/11/17 07:34:26 AM by Ying Liu

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