The number of breast cancer (BC) cases is growing worldwide, being most frequently diagnosed in the early-setting. Mammaprint™ is a 70-gene-expression signature, originally designed for selecting early BC patients with low risk of developing metastasis, so that they could be spared adjuvant chemotherapy. Its use as a prognostic biomarker has been extensively validated, both retrospectively and prospectively. However, its value as a predictive tool and as a clinically useful tool remains controversial. This review will describe how the test works, its application in the clinic and its limitations. Cost-effectiveness studies will be summarized. Finally, we will provide a perspective on the use of Mammaprint in the near future, as a valuable tool for personalizing the treatment of early BC patients.
with longer durations of treatment. Fortunately, clinical experience suggests that the risk of trastuzumab-associated cardiac injury is lower with nonanthracycline regimens, and that the vast majority of these instances of cardiotoxicity are asymptomatic changes in LVEF, which lack important clinical sequelae.A patient with early stage, HER2þ breast cancer wants 'the best' treatment to prevent cancer recurrence while preserving quality of life and avoiding serious, long-term consequences of therapy. That treatment undeniably includes trastuzumab, given concurrently with taxane-based chemotherapy. The 'gains' of longer trastuzumab therapy are quite modest, amounting to single-digit reductions in recurrence rates for women with average risk, HER2þ tumors. For patients who developed cardiac toxicity or otherwise do not tolerate trastuzumab, or in situations where only shorter durations of trastuzumab are available, it seems clear that the 'lion's share' of benefit is achievable with 6 months of treatment. But based on the data in Short-HER2 and four other trials of treatment duration, we believe that 12 months of trastuzumab, including 3 months of concurrent administration with taxane-based chemotherapy, remains the standard of care and the optimal duration of therapy. Lesser durations of trastuzumab maintenance treatment appear associated with a greater risk of disease recurrence. Finally, in cases of higher risk, HER2þ breast cancer, current treatment standards may include additional anti-HER2 therapies such as pertuzumab or neratinib. We note that there are simply no data that these interventions benefit women who received less than 12 months of trastuzumab.One year is a long time, especially when getting treatment of breast cancer. But for most women with HER2þ tumors, that looks like time well spent.
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