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Annals of Oncology Advance Access originally published online on January 15, 2009
Annals of Oncology 2009 20(6):993-999; doi:10.1093/annonc/mdn739
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

reviews

Role of biologic therapy and chemotherapy in hormone receptor- and HER2-positive breast cancer

A. U. Buzdar*

Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA

* Correspondence to: Prof. A. U. Buzdar, Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Unit 1354, 1515 Holcombe Boulevard, Houston, TX 77030, USA. Tel: +1-713-792-2817; Fax: +1-713-794-4385; E-mail: abuzdar{at}mdanderson.org

Background: To review the efficacy of chemotherapy and human epidermal growth factor receptor 2 (HER2)-targeted therapy when used in addition to hormonal therapy for the optimal management of estrogen receptor-positive (ER+)/human epidermal growth factor receptor 2-positive (HER2+) breast cancer.

Design: Literature published from January 2003 to March 2008 was reviewed to assess the use of chemotherapy and biologic therapy in addition to hormonal agents.

Results: Aromatase inhibitors (AIs) demonstrated greater effectiveness in the adjuvant setting than tamoxifen for the management of ER+ and HER2+ breast cancer. Evidence of cross talk between HER2- and ER-signaling pathways suggests that combined treatment with HER2 blockade and hormonal therapy may offer clinical advantages beyond those provided by hormonal therapy alone in ER+/HER2+ disease. Combined therapy with trastuzumab plus an aromatase AI significantly improves progression-free survival, response rates, and clinical benefits when compared with AI monotherapy in postmenopausal women. Several large studies demonstrated that trastuzumab significantly improves disease-free and overall survival when given in combination with, or following, chemotherapy, regardless of hormone receptor status.

Conclusions: HER2-targeted therapy maybe combined with AIs for the treatment of ER+/HER2+ metastatic breast cancer in postmenopausal women. HER2-targeted therapy in combination with AIs for treatment of ER+/HER2+ early breast cancer needs to be prospectively evaluated.

Key words: aromatase inhibitor, breast cancer, chemotherapy, estrogen receptor, HER2, trastuzumab

Received for publication August 6, 2008. Revision received November 3, 2008. Accepted for publication November 6, 2008.


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