Few facts

Human epidermal growth factor 2 (HER2)

Cancer type HER2 plus (HER2+) it’s a type of cancer that affects around 20% of all breast cancer patients and around 16% of all stomach cancer patients. Develops faster than other cancers and causes metastasis.

Personalized breast cancer treatment is based on the presence (or absence) of hormone receptors and/or the overexpression (excess) of HER2 in the tumour. In addition, the availability of gene expression tests that can predict how likely it is that the cancer will come back (recurrence) allows physicians to personalize treatment to the specific risk of the individual.

Personalized treatment options for breast cancer

Treatment base Type of breast cancer according to biomarkers Approved/recommended treatment Notes
Hormone therapy
trastuzumab (Herceptin) HER2+

HER2+ metastatic breast cancer

▪ In combination with a chemotherapy regimen of doxorubicin plus cyclophosphamide, followed by either paclitaxel or docetaxel

▪ In combination with a chemotherapy regimen of docetaxel and carboplatin

▪ As a single agent following chemotherapy that includes an anthracycline (doxorubicin, epirubicin, pegylated liposomal doxorubicin)

▪ In combination with paclitaxel for first-line treatment

▪ As a single agent after failure of one or more chemotherapy regimens
Approved for use in 1998
lapatinib (Tykerb) HER2+ metastatic breast cancer ▪ In combination with capecitabine after failure of anthracyclines, taxanes (paclitaxel or docetaxel) and trastuzumab Approved for use in 2007
ER+/PR+, HER2+ breast cancer ▪ In combination with letrozole Approved for use in 2010
pertuzumab (Perjeta) HER2+ metastatic breast cancer ▪ In combination with trastuzumab anddocetaxel Approved for use in 2012
everolimus (Afinitor) ER+/PR+, HER2- metastatic breast cancer ▪ In combination with exemestane after failure of letrozole or anastrozole Approved for use in 2012
ixabepilone (Ixempra) Triple-negative (ER-/PR-, HER2-) metastatic breast cancer ▪ In combination with capecitabine Used in clinical trials only

Source: Patient Resource https://www.patientresource.com/Personalized_Treatment_Targeted_Therapy.aspx

Anaplastic lymphoma kinase (ALK)

  • Now, in recent years more effective therapies have been developed to target very specific molecules or pathways that influence the cancer tumour. One example is the anaplastic lymphoma kinase (ALK). Clinical trials have shown that patients with tumour driven by these aberrant genes can be treated with very specific drugs resulting in response rates of over 60%.
  • For 100 patients 3 test positive for ALK
  • Currently in Europe biomarker for ALK should be tested in all patients with advanced lung cancer. For ALK positive lung cancer 2nd line treatment crizotinib is advised.

Epidermal growth factor receptor, EGFR

  • For tumours with EGFR activating mutations first line treatment is indicated with an EGFR tyrosine kinase inhibitor (EGFR TKI; gefitinib, erlotinib, afatinib)
  • EGFR mutation analysis is the best predictive marker for the use of EGFR TKI therapy in non-small cell lung cancer (NSCLC). Deletions in ex19 and point mutation L858R in ex21 occur most frequently and are associated with around 70% response rate on EGFR TKI therapy
  • EGFR mutations need sensitive techniques to reach 1-10% sensitivity such as NGS

treatment options for colorectal cancer

Type Treatment Notes
EGFR cetuximab (Erbitux), panitumumab (Vectibix) Beneficial for patients with metastatic colorectal cancer
KRAS Standard chemotherapy, other treatments cetuximab (Erbitux) and panitumumab (Vectibix) should not be used
BRAF More studies are needed
MMR 5-FU (conventional chemotherapy) Effective for those with a high expression of MMR protein

Source: Patient Resource https://www.patientresource.com/Personalized_Treatment_Targeted_Therapy.aspx