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Patients with HER2-positive breast cancer often need to undergo aggressive treatment, but ongoing research is determining if chemotherapy can be scaled back for certain patients.
HER2-positive breast cancer — which makes up approximately 15% to 20% of breast cancer diagnoses, according to the American Cancer Society — tends to be an aggressive subtype, so the current treatment strategy is to administer chemotherapy to anyone whose tumor is 1 centimeter or larger, explained Dr. Naomi Dempsey, a medical oncologist at Miami Cancer Institute, Baptist Health, in Florida.
However, researchers are exploring the possibility of giving less aggressive treatment to patients with stage 1 disease to avoid potentially unnecessary side effects from chemotherapy. For this reason, according to Dempsey, it is important that patients talk with their clinicians about ongoing clinical trials that they may be eligible for.
I think it's important to know that when you have a HER2-positive breast cancer, it's a more aggressive type of breast cancer than the breast cancer that you've heard about. And that generally means that it requires chemotherapy for any tumor that's bigger than half a centimeter, which is about the size of a pencil eraser, we're giving chemotherapy.
Certainly some patients say, “My tumor is tiny. Do I really need chemotherapy?” But when it comes to HER2-positive breast cancer, the answer is yes, because we saw in the past, before we had really good treatments for HER2-positive breast cancer, outcomes were really not what we were wanting to see; we weren't getting the cure rates that we were getting in other types of breast cancers.
Now by giving more aggressive treatment, we're really able to bring the outcomes of HER2-positive breast cancer up to the level that they are in other types of breast cancers. So, I would say No. 1 is that you are going to get more aggressive treatment. Another takeaway is that we've really done a lot of work in in HER2-positive breast cancer in determining exactly how much treatment is needed, because we've really improved outcomes and early-stage HER2-positive breast cancer with more aggressive treatments.
Right now, some of what we're thinking about, particularly in stage 1 breast cancers that are only in the breast — the size of about a cranberry or smaller is a stage 1 — we're finding that maybe we're over treating some of these patients. We're getting great outcomes, but we're wondering, “do you really need to lose your hair? Or have the risk of permanent neuropathy? Can we do less toxic treatment and still have the great outcomes that we've been seeing in recent years?” And so that is an area that we're really focusing on in clinical trials. And it's another reason it's really important to ask about what clinical trials are available in your area, because perhaps you could go on one of these clinical trials where you get less toxic treatment that we are hoping to find is every bit as effective as the stronger treatments.
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