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Advancing HER2-low breast cancer management: enhancing diagnosis and treatment strategies Cover

Advancing HER2-low breast cancer management: enhancing diagnosis and treatment strategies

Radiology and Oncology
Volume 58 (2024): Issue 2 (June 2024)
By: Simona Borstnar,  Ivana Bozovic-Spasojevic,  Ana Cvetanovic,  Natalija Dedic Plavetic,  Assia Konsoulova,  Erika Matos,  Lazar Popovic,  Savelina Popovska,  Snjezana Tomic and  Eduard Vrdoljak  
Open Access
|Jun 2024

Figures & Tables

FIGURE 1.

Algorithms for HER2-low mBC in light of evolving treatment paradigms, according to the HR status and other actionable targets: (A) HR+ and (B) HR−. The ideal scenario considers availability of all treatments in all lines and unrestricted treatment access. 1L/2L/3L/4L = first/second/third/fourth line; BRCAm = BReast CAncer gene mutations; BRCAwt = BReast CAncer gene wild type; CDK4/6i = cyclin-dependent kinase 4/6 inhibitor; CTx = chemotherapy; ET = endocrine therapy; HER2 = human epidermal growth factor receptor 2; HR = hormone receptor; IO = immunotherapy; mBC = metastatic breast cancer; mTORi = mammalian target of rapamycin inhibitor; PARPi = poly(adenosine diphosphate ribose) polymerase inhibitor; PD-L1 = programmed death-ligand 1; PI3Km = phosphatidylinositol 3-kinases mutations; PIK3wt = phosphatidylinositol 3-kinases wild type; SG = sacituzumab govitecan; T-DXd = trastuzumab deruxtecan. Treatment in 2L, 3L, 4L, and further lines is based on: previous therapy received; duration of response to previous treatment; patient’s preferences, condition, and comorbidities; toxicities of previous therapies; presumed benefit of further lines of therapy; and treatment availability. Per current approved label, trastuzumab deruxtecan as monotherapy is indicated for the treatment of adult patients with unresectable or metastatic HER2-low breast cancer who have received prior chemotherapy in the metastatic setting or developed disease recurrence during or within 6 months of completing adjuvant chemotherapy. Per current approved label, sacituzumab govitecan as monotherapy is indicated for the treatment of adult patients with unresectable or metastatic triple-negative BC who have received two or more prior systemic therapies, including at least one of them for advanced disease.
Algorithms for HER2-low mBC in light of evolving treatment paradigms, according to the HR status and other actionable targets: (A) HR+ and (B) HR−. The ideal scenario considers availability of all treatments in all lines and unrestricted treatment access. 1L/2L/3L/4L = first/second/third/fourth line; BRCAm = BReast CAncer gene mutations; BRCAwt = BReast CAncer gene wild type; CDK4/6i = cyclin-dependent kinase 4/6 inhibitor; CTx = chemotherapy; ET = endocrine therapy; HER2 = human epidermal growth factor receptor 2; HR = hormone receptor; IO = immunotherapy; mBC = metastatic breast cancer; mTORi = mammalian target of rapamycin inhibitor; PARPi = poly(adenosine diphosphate ribose) polymerase inhibitor; PD-L1 = programmed death-ligand 1; PI3Km = phosphatidylinositol 3-kinases mutations; PIK3wt = phosphatidylinositol 3-kinases wild type; SG = sacituzumab govitecan; T-DXd = trastuzumab deruxtecan. Treatment in 2L, 3L, 4L, and further lines is based on: previous therapy received; duration of response to previous treatment; patient’s preferences, condition, and comorbidities; toxicities of previous therapies; presumed benefit of further lines of therapy; and treatment availability. Per current approved label, trastuzumab deruxtecan as monotherapy is indicated for the treatment of adult patients with unresectable or metastatic HER2-low breast cancer who have received prior chemotherapy in the metastatic setting or developed disease recurrence during or within 6 months of completing adjuvant chemotherapy. Per current approved label, sacituzumab govitecan as monotherapy is indicated for the treatment of adult patients with unresectable or metastatic triple-negative BC who have received two or more prior systemic therapies, including at least one of them for advanced disease.

Overview of cancer epidemiology across four CEE countries in 2020 (data extracted from GLOBOCAN 202025 and the European Cancer Information System34)

CharacteristicsBulgariaCroatiaSerbiaSlovenia
Total population6 948 4454 105 2688 737 3702 078 932
Number of new cancer cases (all cancer sites)36 45126 09249 04314 180
Incidence age-standardized rate per 100 000100120.3145.3121.2
Number of new BC cases in 2020, both sexes, all ages406128946724a1410
BC new cases – rank across all types of cancers3223
5-year prevalence, all ages (per 100 000)425.45523.4549.32560.03
Mortality age-standardized rate per 100 00036.332.850.932.3
Number of BC deaths15338322342405
BC deaths – rank across all types of cancers3325
Mortality-to-incidence ratiob0.360.270.350.27

Status of reimbursement for anticancer drugs used for treatment of HER2-negative mBC in Bulgaria, Croatia, Serbia, and Slovenia, including the year of reimbursement of at least one representative of the class

TreatmentBulgariaaCroatiaSerbiacSloveniad
CDK4/6 inhibitors2018201820222018
Alpelisib2023202120232021
PARP inhibitors2023202220212021
Sacituzumab govitecan 20232022
Trastuzumab deruxtecan 20222023
Atezolizumab nab-paclitaxel 202220212020
Pembrolizumab2023b 20222023
EverolimusBy >10 years 20212010
FulvestrantBy >10 yearsBy >10 years20192004
Aromatase inhibitorsBy >10 yearsBy >10 years2008By >20 years
DOI: https://doi.org/10.2478/raon-2024-0030 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Journal RSS Feed
Language: English
Page range: 258 - 267
Submitted on: Jan 4, 2024
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Accepted on: May 14, 2024
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Published on: Jun 11, 2024
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
HER2-low,
metastatic breast cancer,
Balkans,
testing,
innovative treatment,
access
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2024 Simona Borstnar, Ivana Bozovic-Spasojevic, Ana Cvetanovic, Natalija Dedic Plavetic, Assia Konsoulova, Erika Matos, Lazar Popovic, Savelina Popovska, Snjezana Tomic, Eduard Vrdoljak, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

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