Summary

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• Kadcyla (ado-trastuzumab emtansine) is indicated for the treatment of patients with HER2-positive metastatic breast cancer who have previously received trastuzumab and a taxane, separately or in combination. Patients should have either received prior therapy for metastatic disease or developed disease recurrence during or within six months of completing adjuvant therapy. It is also indicated for the adjuvant treatment of patients with HER2-positive early breast cancer who have residual invasive disease after neoadjuvant taxane and trastuzumab-based treatment.
• This summary is based on the review of 87 systematic review(s)/meta-analysis(es). ^[1-87]
• Trastuzumab, when combined with chemotherapy, significantly enhances disease-free survival (DFS) and overall survival (OS) in HER2-positive breast cancer patients, with 12 months identified as the optimal duration to reduce recurrence and mortality.
• In patients with brain metastases, Trastuzumab Deruxtecan (T-DXd) showed a median progression-free survival (PFS) of 15 months and a 61% objective response rate (ORR), demonstrating significant intracranial activity.
• The combination of Trastuzumab with Pertuzumab and chemotherapy exhibited superior efficacy in progression-free survival (PFS) and overall survival (OS) compared to Trastuzumab alone, particularly in advanced HER2-positive breast cancer.
• For hormone receptor-positive HER2-positive diseases, dual-targeted therapy combined with endocrine therapy improved progression-free survival (PFS) outcomes.
• Trastuzumab is associated with an increased risk of left ventricular ejection fraction (LVEF) decline, particularly when used with anthracyclines; common adverse effects include infections, gastrointestinal disorders, and respiratory disorders.
• Trastuzumab Deruxtecan (T-DXd): Most common grade 3 or higher adverse events are neutropenia, anemia, and interstitial lung disease (ILD); higher incidence of fatigue compared to T-DM1.
• Pyrotinib: Common adverse events are diarrhea, anemia, vomiting, and leucopenia; no treatment-related deaths reported.
• Older patients receiving Trastuzumab are more prone to cardiac side effects, highlighting the need for careful monitoring in this age group to manage potential cardiotoxicity.