In the mid-1980s, amplifi cation of the gene encoding ErbB2/HER2 was the fi rst consistent genetic alterations detected in human breast tumors (1, 2). ErbB2/HER2 belongs to the epidermal growth factor (EGF/ErbB) family of receptor tyrosine kinases (RTK). Th e ErbB2 amplicon on chromosome 17q12-21, which is detected in approximately 20% of breast tumors, correlates with dramatic overexpression of the receptor. Soon after discovery of ErbB2 gene amplifi cation it was recognized that patients with elevated receptor levels had a poor clinical prognosis (reviewed in (3, 4) ). Since then, ErbB2/HER2 has been intensely studied not only to understand its role in cancer biology but also to target the receptor with anti-cancer therapeutics. Currently, various ErbB2/HER2 targeted inhibitors area in clinical use. Th ese include the monoclonal antibodies trastuzumab and pertuzumab that bind the receptor's extracellular domain, and small molecule tyrosine kinase inhibitors that inhibit the enzymatic activity of the kinase domain. In this review our understanding of how ErbB2 receptor are activated and contribute to cancer development will be described. Furthermore, the development of anti-ErbB2/HER2 targeted therapeutics for clinical use will be discussed taking into consideration the current views on their mechanism of action. Potential mechanisms that underlie a successful clinical response to inhibition of ErbB2, as well as possible reasons for non-response will also be discussed.
ErbB Receptor PathwayErbB Receptor Activation ErbB2/HER2 belongs to the EGF/ErbB family of RTK, which also includes EGFR/ ErbB1, HER3/ErbB3 and HER4/ErbB4. Th e various names for the receptors refl ect their discovery in diff erent organisms and I will refer to them as the ErbB receptor family (EGFR, ErbB2, ErbB3 and ErbB4) throughout this review. Each of the receptors has an extracellular ligand binding region, a single membrane spanning region and a cytoplasmic tyrosine kinase containing domain.Th e EGF-family of peptides bind the ErbB receptors and based upon their receptor specifi city are divided into three groups. Th e fi rst group includes EGF, transforming growth factor (TGF)-α, amphiregulin (AR) and epigen (EPG), which bind specifi cally to EGFR; the second group includes betacellulin (BTC), heparin-binding EGF (HB-EGF) and epiregulin (EPR), which exhibit dual specifi city, binding both EGFR and ErbB4. Th e third group, composed of the neuregulins (NRGs), forms two subgroups based upon their capacity to bind ErbB3 and ErbB4 (NRG-1 and NRG-2) or only ErbB4 (NRG-3 and NRG-4) (5, 6). Ligand binding to