Huang Xiang, Hua Yijia, Sun Chunxiao, Yin Yongmei
Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Gusu School, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
Transl Breast Cancer Res. 2024 Oct 31;5:30. doi: 10.21037/tbcr-24-40. eCollection 2024.
Human epidermal growth factor receptor 2 (HER2)-low breast cancer is a newly identified targetable subset of breast tumors, and its clinical characteristics and treatment strategies are controversial. The emergence of novel anti-HER2 antibody-drug conjugate (ADC) has brought promising approaches for HER2-low breast cancer treatment. Several clinical trials have validated the efficacy and safety of trastuzumab deruxtecan (T-Dxd) in HER2-low breast cancer at different treatment settings. The treatment timing, candidate identification, long-term management, and overcoming drug resistance are crucial questions to improve breast cancer patient survival. Here we present a clinical case of hormone receptor-positive (HR) HER2-low breast cancer patient who experienced neoadjuvant chemotherapy, surgery, adjuvant, and first-line endocrine therapy with limited effectiveness. After the treatment failure of CDK4/6 inhibitors, the utilization of T-Dxd brought a long-term disease response and tolerable low toxicities. In this round table discussion, we summarized opinions and recommendations from breast cancer surgeons and oncologists on treatment strategies for this patient. The discussion mainly focused on the precise diagnosis of HER2-low breast cancer, treatment design at different disease status, regimens selection according to drug response, strategies consideration for overcoming drug resistance and the management of adverse events in long-term survival. These opinions would provide critical insights to improve HER2-low breast cancer treatment and offer valuable suggestions for clinical practice.
人表皮生长因子受体2（HER2）低表达乳腺癌是一种新发现的可靶向治疗的乳腺肿瘤亚型，其临床特征和治疗策略存在争议。新型抗HER2抗体药物偶联物（ADC）的出现为HER2低表达乳腺癌的治疗带来了有前景的方法。多项临床试验验证了曲妥珠单抗德曲妥珠单抗（T-Dxd）在不同治疗场景下对HER2低表达乳腺癌的疗效和安全性。治疗时机、候选患者识别、长期管理以及克服耐药性是提高乳腺癌患者生存率的关键问题。在此，我们展示一例激素受体阳性（HR）HER2低表达乳腺癌患者的临床病例，该患者接受了新辅助化疗、手术、辅助治疗及一线内分泌治疗，但疗效有限。在CDK4/6抑制剂治疗失败后，使用T-Dxd带来了长期的疾病缓解且毒性较低、可耐受。在本次圆桌讨论中，我们总结了乳腺癌外科医生和肿瘤学家对该患者治疗策略的意见和建议。讨论主要集中在HER2低表达乳腺癌的精准诊断、不同疾病状态下的治疗设计、根据药物反应选择治疗方案、克服耐药性的策略考量以及长期生存中不良事件的管理。这些意见将为改善HER2低表达乳腺癌的治疗提供关键见解，并为临床实践提供有价值的建议。
