HER2, or human epidermal growth factor 2, is a special protein (receptor) on the surface breast cancer cells, and it controls the growth of the cancer cells. The HER2 protein is present as a result of overexpression or amplification of the oncogene ERBB2. A tumor is considered HER2 positive by either the presence of HER2 protein presence and/or the overexpression of HER2 gene (the ERBB2). HER2 positive tumors are considered aggressive and have a tendency to recur, however, there are newer medications targeting HER2-positive cancer and led to significant improvement in outcome. 15% to 20% of all invasive breast cancer is reported to be HER2 positive. In this post, I will discuss the treatment of metastatic HER2 positive disease only, the nonmetastatic disease will be presented at a later date.
her2 testing must be done on biopsy material of metastatic site in all patients.
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Elderly breast cancer is rising. Increasing age is considered a risk factor for developing breast cancer. With older age generally defined as age ≥65, it estimated that nearly half of all new breast cancer diagnosis occurring in such age group.
Multiple studies documented that elderly breast cancer patients are treated differently.
Continue reading “Management of Breast Cancer in the Elderly”
Background: Sentinel lymph node biopsy (SLNB) is now the standard of care used in the staging of the regional lymph nodes in breast cancer. As result of the wide adoption of SLNB attention turned into a detailed examination of the biopsied lymph node(s) and subsequent rise in the incidence of finding lymph node micrometastases. Micrometastases(pN1mi) is defined as a metastatic disease in the lymph node that is less than 2.0 mm but larger than 0.2mm. Isolated tumor cells (ITC) is defined as a metastatic disease in the lymph node that is smaller or equal to 0.2mm. With the rise of incidence of axillary micrometastases, there is a considerable debate on the prognostic significance and appropriate treatment recommendations for such patients.
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Triple negative (TNBC) metastatic breast cancer is a heterogeneous disease, chemotherapy remains the mainstay of treatment, however, new treatments based on identifying molecular subtypes, stratifying TNBC based on gene expression assays with subsequent specific targeted therapy is an area of intense clinical research. In this post, I will review our current standard clinical practice and explore ongoing and future clinical directions.
Metastatic TNBC is very heterogenous, and while Basal type is most common, it only account for nearly 80% of all cases.
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