MY LIFE Matters: TNBC Patient Voices Issue 2022 - 45

CLINICAL TRIALS Conversation
WHAT IS HER2 POSITIVE BREAST
CANCER ?
When breast cancer is classified as HER2-positive, it means
that the breast cancer tissue overexpresses a protein called
human epidermal growth factor receptor 2 (HER2). These
breast cancer cells have too many HER2 receptors, pick up
signals telling them to grow, and multiply too quickly, forming
a tumor (DePolo 2022).
In order to determine whether a person's breast cancer is
HER2-positive, a biopsy is taken and then an immunohistochemical
(IHC) test is conducted. The IHC test assesses
the amount of HER2 receptor protein on the surface of
cells in the sample of breast cancer tissue, and gives a score
ranging from 0-3+.
Under previous guidelines, if a person's tumor shows
HER2 expression that is IHC 0-1+, the cancer is considered
HER2-negative (Modi, et al. 2022). If the results are IHC
2+, then breast cancer is considered borderline. Only if
the results are IHC 3+ can the breast cancer be classified
as HER2-positive.
TREATING HER2-POSITIVE BREAST
CANCER
Studies show that patients with HER2-positive breast cancer
have the highest five-year survival rates compared to patients
with other breast cancer subtypes. The reasons for this
phenomenon include the fact that HER2-positive patients
can benefit from therapies that target HER2 receptors (Purrington
et al. 2020).
Previously, breast cancers classified by the IHC test as IHC
1+ and IHC 2+ have not been classified as HER2-positive.
This means that only people whose breast cancer tested
IHC 3+ could benefit from targeted therapy, while patients
with an IHC score of less than IHC 3+ were considered to
have HER2-negative breast cancer.
The results of this new clinical trial specifically show
that for patients with lower HER2 expression, trastuzumab
deruxtecan can still be an incredibly effective treatment.
CLINICAL TRIAL FINDINGS
The findings from the trastuzumab deruxtecan study
published in June 2022 are significant because as many as
half of all breast cancer patients have tumors with a HER2
score of 1+ or 2+, which means that a large proportion of
people diagnosed with breast cancer have previously not
been eligible for HER2-targeted therapies.
Now that trastuzumab deruxtecan has been found to be
successful in patients with metastatic breast cancer that
have low HER2 overexpression, a new standard of care for
treating this large proportion of metastatic breast cancer
patients can be developed.
Dr. Corinne Jordan, a general surgeon specializing in
breast cancer explains, " The findings really illustrate the
spectrum of breast cancer, and tailoring treatment is often
WHAT THIS MEANS FOR TNBC
Triple-negative breast cancer is twice as common among
Black women compared to White women (Lund et al. 2009).
A triple-negative breast cancer diagnosis can mean that one
may not benefit from effective targeted therapies that exist
for people with other subtypes of cancer. With a new HER2low
category, patients who have historically been considered
HER2-negative may now be able to benefit from targeted
treatments.
For Black women whose breast cancer
was formerly considered triple negative,
and who have HER2-low status, there
is hope that we can recategorize this
group from one with worse outcomes to
a population that can live longer with
HER2 targeted treatment.
Although this may sound simple, we need awareness and
interventions from multiple aspects of the healthcare system to
ensure that Black women find out whether they have HER2-low
overexpression.
According to New York City-based licensed master social
worker Lisa Petgrave-Nelson , LMSW, OSW-C, culturally
sensitive and appropriate support is necessary in order to reach
populations of Black cancer patients when motivating people
to go in for IHC or genetic testing. " It is important for the staff
working in healthcare institutions to look like the populations
being served. " If healthcare centers with a larger demographic
of Black patients employ diverse medical staff members, it
allows for patient centered care and a true representation of
the patients being served. Patient-centered care includes cultural
humility and awareness about the needs specific to Black
cancer patients, which can lead to better survival outcomes.
(Velasquez et al. 2022).
Moreover, racial bias in the healthcare system often takes
the form of microaggressions (Velasquez et al. 2022). Lisa
Petgrave-Nelson also explained that Black patients often do not
feel heard or taken seriously in healthcare settings, making it
unlikely they will utilize all aspects of the healthcare system. To
help minimize bias, healthcare institutions can implement standardized
procedures, such as consultations about IHC or genetic
testing for all people diagnosed with cancer. Standardized procedures
limit implicit bias, giving every patient the opportunity
to benefit from targeted therapies that may be suitable.
MY LIFE MATTERS
TNBC PATIENT VOICES ISSUE 2022
45
MY LIFE Matters: TNBC Patient Voices Issue 2022

Table of Contents for the Digital Edition of MY LIFE Matters: TNBC Patient Voices Issue 2022
