Expert: ‘It’s an exciting time’ to treat HER2-positive breast cancer in young patients
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Key takeaways:
- Young patients with HER2-positive breast cancer face unique concerns when diagnosed.
- Controlling for other known prognostic factors, young patients have similar outcomes as older patients.
HER2-positive breast cancer has become one of the most treatable breast cancer types among patients of all ages, including those aged 40 years and younger.
“Experts are amassing an ever-growing array of targeted therapies and fine-tuning the approach to treating HER2-positive breast cancer, which will enable us to better treat young patients and help them live longer, but also help them live a better overall quality of life,” Megan E. Tesch, MD, MPH, medical oncologist at The Breast Oncology Center at Dana Farber Cancer Institute, told Healio.
Aggressive disease biology
Breast cancers that arise in patients aged younger than 40 years are more likely to have aggressive disease biology, including HER2 overexpression. It is estimated that 25% or more of young patients with breast cancer have the HER2-positive subtype.
“Compared with patients older than 40 years, those aged younger than 40 years are more likely to present with symptoms and at a more advanced stage,” Tesch said. “That is in part because of diagnostic delays and lack of reliable screening.”
For that reason, young patients with HER2-positive breast cancer more often require preoperative or neoadjuvant therapy to downstage their tumor, facilitate surgery and assess treatment response, she added.
Additionally, young patients with HER2-positive breast cancer face a variety of concerns that are unique to or accentuated by their stage of life when diagnosed.
“Fertility, body image and sexual dysfunction can contribute to the increased risk for psychological distress seen in this age group,” she said. “Also, the commonly used HER2-targeted therapy trastuzumab [Herceptin, Genentech] has teratogenic risks, so young patients have to be very careful not to get pregnant while receiving this therapy, and are counseled regarding the need for effective contraception.”
As Healio previously reported, the Young Women’s Breast Cancer Study (Helping Ourselves, Helping Others) — a multi-institutional cohort study launched in 2006 that has enrolled more than 1,300 women aged 40 years or younger with breast cancer — set out to examine disease biology and genetic risk factors, as well as other issues particularly important to young adults, such as sexual functioning, fertility, genetic testing and body image.
Results of a survey of women who enrolled in the study showed about 40% expressed interest in future fertility, but only 10% of those interested actually pursued fertility preservation strategies at the time of diagnosis. Further, about 10% of patients at least 5 years from diagnosis went on to have a pregnancy.
“Fortunately, when controlling for other known prognostic factors, such as tumor size and lymph node status, young patients with HER2-positive breast cancer have similar outcomes as older patients,” Tesch said. “Young age does not impact prognosis in HER2-positive breast cancer, and young patients derive equivalent benefit from HER2-targeted therapies.”
Another unique feature of HER2-positive breast cancer in young patients is that they are more likely to present with de novo metastatic disease.
“Fortunately, though, de novo metastatic HER2-positive breast cancer often responds very well to HER2-directed therapies,” Tesch said.
Looking ahead
The treatment of HER2-positive breast cancer is continually moving toward using less chemotherapy and more HER2-targeted therapy, according to Tesch.
“We know that HER2-targeted therapy is the most targeted therapy for this breast cancer type, and it tends to have less side effects than chemotherapy,” she said. “What’s important is that young patients are adequately represented in these studies exploring using less chemotherapy, and that will ensure that they can avail of these same treatment options as older patients and avoid overtreatment based solely on their age.”
Additionally, Tesch said more research is needed to confirm the efficacy of some of the more novel HER2-targeted therapies, such as fam-trastuzumab deruxtecan-nxki (Enhertu; AstraZeneca, Daiichi Sankyo).
“Fam-trastuzumab deruxtecan-nxki has become a very popular type of therapy for this type of breast cancer, and so we need some data confirming that that is effective in patients younger than 40 years specifically, just like it was confirmed for trastuzumab,” Tesch said. “It’s an exciting time to be to be treating this type of breast cancer and treating young patients with this subtype.”
Reference:
For more information:
Megan E. Tesch, MD, MPH, can be reached at megane_tesch@dfci.harvard.edu.
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