How is HER2/neu-positive locally advanced breast cancer treated?

Updated: Apr 23, 2020
  • Author: Joseph A Sparano, MD; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

Answer

In patients with HER2/neu-positive disease, concurrent trastuzumab with chemotherapy improves the pCR rate. Regimens are listed below.

AC-paclitaxel plus trastuzumab

  • Doxorubicin 60 mg/m 2 IV  plus  cyclophosphamide 600 mg/  2 IV on day 1 every 3 wk for 4 cycles, followed by
  • Paclitaxel 80 mg/m 2 IV weekly for 12 weeks or paclitaxel 175mg/m2 every 3 wk for 4 cycles with:
  • Trastuzumab 4 mg/kg IV with first dose of paclitaxel, followed by
  • Trastuzumab 2 mg/kg IV weekly to complete 1-y total duration of trastuzumab therapy
  • As an alternative, trastuzumab 6 mg/kg IV every 3 wk following the completion of paclitaxel, to complete 1-y total duration of trastuzumab therapy [14]

Dose-dense AC–paclitaxel plus trastuzumab

  • Doxorubicin 60 mg/m 2 IV  plus  cyclophosphamide 600 mg/m 2 IV on day 1 every 2 wk for 4 cycles, followed by
  • Paclitaxel 175 mg/m 2 IV every 2 wk for four cycles, with
  • Trastuzumab 4 mg/kg for the first dose and then 2 mg/kg weekly for 1-y total duration
  • As an alternative, trastuzumab 6 mg/kg every 3 wk following the completion of paclitaxel, and given to complete 1-y total duration of trastuzumab therapy​ [15]

AC-docetaxel plus trastuzumab

  • Doxorubicin 60 mg/m 2 IV  plus  cyclophosphamide 600 mg/m 2 IV on day 1 every 3 wk for four cycles, followed by
  • Docetaxel 100 mg/m 2 every 3 wk for four cycles, with
  • Trastuzumab 4 mg/kg IV during week 1 and then 2 mg/kg IV weekly for 11 wk; followed by trastuzumab 6 mg/kg every 3 wk to complete 1 y of trastuzumab ​ [15]

AC-paclitaxel plus trastuzumab and pertuzumab

  • Doxorubicin 60 mg/m 2 IV  plus  cyclophosphamide 600 mg/m 2 IV on day 1 every 3 wk for four cycles, with
  • Followed by paclitaxel 80 mg/m 2 IV days 1, 8, 15 every 3 wk for four cycles with
  • Pertuzumab 840 mg IV followed pertuzumab 420mg IV and trastuzumab 8 mg/kg IV for the first dose and then 6 mg/kg IV every 3 wk for four cycles 
  • Then, trastuzumab 6 mg/kg IV every 3 wk to complete 1-yr trastuzumab therapy

AC-docetaxel plus trastuzumab and pertuzumab

  • Doxorubicin 60 mg/m 2 IV  plus  cyclophosphamide 600 mg/m 2 IV on day 1 every 3 wk for four cycles
  • Followed by docetaxel 75-100 mg/  2 every 3 wk for four cycles, with
  • Pertuzumab 840 mg IV followed pertuzumab 420 mg IV and trastuzumab 8 mg/kg IV followed by trastuzumab 6 mg/kg every 3 wk for four cycles
  • Trastuzumab 6 mg/kg every 3 wk to complete 1 y of trastuzumab therapy

TCH plus pertuzumab

  • Docetaxel 75 mg/m 2  plus   carboplatin AUC 6 IV every 3 wk for 6 cycles with
  • Pertuzumab 840 mg IV followed pertuzumab 420mg IV and  trastuzumab 8 mg/kg IV followed by trastuzumab 6 mg/kg IV every 3 wk for six cycles, followed by
  • Trastuzumab 6 mg/kg IV every 3 wk to complete 1-y total duration of trastuzumab therapy
  • As an alternative, trastuzumab 8 mg/kg followed by trastuzumab 6 mg/kg every 3 wk to complete 1-y total duration of trastuzumab therapy

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