Table of ContentsView AllTable of ContentsHow Common Is HER2?Early StagesAdvanced StagesIntegrative TreatmentsClinical TrialsSummary
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Table of Contents
How Common Is HER2?
Early Stages
Advanced Stages
Integrative Treatments
Clinical Trials
Summary
If you have HER2-positive breast cancer, your options for treatment will depend on several factors, such as the stage of cancer (early or metastatic) and the hormone receptor status of the tumor.HER2-positive tumors can also be estrogen-receptor-positive (triple-positive breast cancer). However, a tumor’s receptor status can change (from positive to negative or vice versa).Therefore, the HER2-positive breast cancer treatments your oncologist recommends might change as well.
One common treatment for those with HER2-positive breast cancer begins with one or more chemotherapy drugs in addition to trastuzumab, which is an anti-HER2 antibody. Research suggests that this combination improves survival rates for people with HER2-postive breast cancer.
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It’s believed that around 20%-25% of newly diagnosed cases of breast cancers are positive for a genetic mutation that causes HER2 gene amplification.The mutation causes the gene to produce too many HER2/neu proteins (or just HER2 proteins).
In normal amounts, these proteins act as receptors that tell the breast cells how much to grow (and when to stop). When the mutation is present, the overproduction of HER2 proteins drives the growth of breast cancer cells.
Therapies that specifically target HER2 include Herceptin (trastuzumab), Perjeta (pertuzumab), and T-DM1 (trastuzumab emtansine) which is sold under the brand nameKadcycla.
Verywell / Ellen Lindner
Treatment of early-stage HER2-positive breast cancer is similar to that of HER2-negative breast cancer, but it usually also includes a HER2-targeted drug such as Herceptin.
1. Surgery
Alumpectomyormastectomyis typically recommended to remove the tumor in early-stage breast cancer. Radiation therapy may also be recommended either before (neoadjuvant) or after (adjuvant) surgery. Chemotherapy is not usually necessary for cancers at this stage.
If the tumor isDCIS(stage 0) or if it has a favorable genetic profile, further treatment (adjuvant therapy) may not be necessary once the tumor has been removed.
Adjuvant therapy is usually recommended for large tumors and those withpositive lymph nodes(stage II) as well as for tumors that are growing into surrounding tissue and spreading to lymph nodes (stage III).
Metastatic cancer (stage IV) has specific treatment protocols and does not always involve surgery.
2. Hormonal Therapies
If a tumor isestrogen receptor-positive,hormonal therapiesare recommended. If someone is receiving chemotherapy, hormonal treatments can be started after they finish chemo.
For people who are premenopausal, tamoxifen is often the first choice.Aromatase inhibitorscan be added if someone is postmenopausal. If a premenopausal person needs to take aromatase inhibitors, ovarian suppression therapy, ovarian ablation, or rarely, ovariectomy may be recommended to reduce estrogen levels.
People with early-stage breast cancer who are premenopausal andconsidered high-riskmay want to discuss ovarian suppression with their healthcare provider. Research suggests that in some cases, aromatase inhibitors are associated with slightly higher survival rates than tamoxifen.
3. Chemotherapy
Depending on the cancer stage, tumor size, lymph node involvement, and results of genetic testing, adjuvantchemotherapymay be recommended. Treatment typically begins one month after a lumpectomy or mastectomy and continues for around four to six months.
4. HER2-Targeted Therapies
Before HER2-targeted therapies, HER2 tumors were considered aggressive cancers. With the advent of targeted therapy, survival rates have improved.
A 2017 study found that women withmetastatic breast cancer who were HER2-positiveresponded to Herceptin more favorably than women who were HER2-negative and were not eligible for the treatment.
In 2017, Nerlynx (neratinib) was also approved for people with early-stage HER2-positive breast cancers following treatment with Herceptin.
In 2019 the FDA approved Enhertu (fam-trastuzumab-deruxtecan-nxki) to treat adults with certain types of HER2-positive breast cancer. In 2022, the FDA expanded the use of Enhertu to treat HER2-positive and HER2-low breast cancers that have come back during or within six months of completing treatment for early-stage breast cancer.
In 2023, the FDA approved trastuzumab-deruxtecan (T-DXd) to treat anyone with advanced solid cancer. To qualify for treatment, patients must have already received another treatment first.
According to a 2016 study, when neratinib (a tyrosine kinase inhibitor) was added to standard therapy for breast cancer, complete response rates were higher than they were in people treated with Herceptin plus standard therapy.
Tykerb(lapatinib) is another tyrosine kinase inhibitor that may be used after treatment with Herceptin or other HER2 therapies.
5. Radiation Therapy
For people who choose a lumpectomy,radiation therapyis usually recommended following surgery. For tumors that have four or more positive lymph nodes, radiation therapy after a mastectomy is often considered.
Tumors with one to three positive lymph nodes are in a relative gray zone. In this case, you should talk with both your medical and radiation oncologist about the possible benefits of the treatment.
6. Bone-Modifying Drugs
The addition of bisphosphonate therapy has been considered in early-stage breast cancer, as it may reduce the risk for bone metastases.
With metastatic breast cancer, systemic therapies to control the disease are usually the goal of treatment. Surgery and radiation therapy are considered local therapies and are mainly used only for palliative purposes (to reduce pain and/or prevent fractures).
A biopsy of a metastasis site and repeated receptor studies are recommended to ensure that HER2 status and estrogen-receptor status have not changed.
First-line therapy for advanced HER2-positive breast cancer depends on the results of receptor studies. For people who are HER2-positive, one of the HER2-targeted therapies outlined above is usually used.
If a tumor is also estrogen-receptor-positive, hormonal therapy, HER2 therapy, or both may be considered. Chemotherapy may also be used for several months.
If a tumor has already been treated with Herceptin (trastuzumab) as adjuvant therapy and the disease comes back within six months of ending treatment with adjuvant trastuzumab, the preferred second-line treatment is usually T-DM1.
For someone with early-stage breast cancer who has already received Herceptin in the adjuvant setting but is considered to be at high risk for recurrence, Perjeta (pertuzumab) in combination with trastuzumab and a taxane may be used.
For cancer that progresses after trastuzumab and a taxane in the metastatic setting, T-DM1 is the preferred choice. If a person was not previously treated with Herceptin, the combination of Herceptin, Perjeta, and a taxane may be used.
7. Tykerb and Xeloda Combination
If cancer progresses despite these treatments, a combination of Tykerb (lapatinib) and Xeloda (capecitabine), as well as other chemotherapy regimens or hormonal therapies, can be tried.
8. Bone-Modifying Drugs
HER2-positive breast cancer is more likely to spread to the brain and liver thanHER2-negativetumors.It appears that Herceptin (and possibly Perjeta) can pass theblood-brain barrierand reduce the size of brain metastases.
For people with bone metastases,bone-modifying drugssuch as bisphosphonates can not only reduce the risk of fractures but may improve survival as well.
What is the life expectancy of a HER2-positive breast cancer patient?Life expectancy for those with HER2-positive breast cancer depends on the stage of cancer, the age of the patient, and other variables. That said, generally speaking, survival rates are 90% or higher for most with HER2-positive breast cancer that’s caught early and treated with chemotherapy and an additional antibody therapy.
What is the life expectancy of a HER2-positive breast cancer patient?
Life expectancy for those with HER2-positive breast cancer depends on the stage of cancer, the age of the patient, and other variables. That said, generally speaking, survival rates are 90% or higher for most with HER2-positive breast cancer that’s caught early and treated with chemotherapy and an additional antibody therapy.
Many people ask about alternative therapies when they are diagnosed with breast cancer. There are no proven “natural cures” for breast cancer and no alternative therapies have been found to effectively treat the disease.
However, there are severalintegrative therapies for cancerthat may help people cope with thesymptoms of the diseaseand the side effects of cancer treatments (such asfatigue, anxiety, nausea, peripheral neuropathy, and more).
Some integrative therapies that have been studied specifically in women with breast cancer include yoga,meditation,massage therapy, andacupuncture.
There areclinical trialsexploring surgical, chemotherapy, and radiation therapy options for breast cancer, as well as studies comparing different hormonal and HER2-targeted therapies. Some of the most recent trials have focused on pertuzumab and margetuximab, and many have been conducted around trastuzumab.
Because clinical trials are constantly evolving and emerging, ask your oncologist for more information about options that may be right for you.
In advanced stages, treatment prioritizes systemic therapies, with surgery and radiation primarily for symptom relief. Advanced drugs, like Enhertu and Nerlynx, are options when prior treatments become ineffective, and therapies addressing common brain and bone metastases are also available.
25 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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