Adjuvant therapy

Therapies for HER2-positive breast cancer have dramatically improved outcomes for this once dismal disease. Trastuzumab revolutionized the management of HER2-positive breast cancer and its discovery led to the development of other very effective HER2-targeted therapies. The optimal length of therapy as well as the sequential and concurrent use of trastuzumab with chemotherapy has been studied. The evidence shows one year in the adjuvant setting is the optimal length of treatment and the concurrent use of trastuzumab with chemotherapy (nonanthracycline) is the preferred regimen. Recently, studies with pertuzumab and neratinib have been reported and documented further improvements in outcomes for subsets of patients with HER2-positive breast cancer. Many patients remain disease free when treated with adjuvant chemotherapy plus trastuzumab for one year. Treatment is generally well tolerated with manageable toxicities. However, a sizeable minority of patients do develop recurrent disease and as such there is room for further improvement in outcomes. Herein we review the adjuvant management of HER2-positive breast cancer and ongoing studies that investigate novel therapies in this setting.