- With Mayo Clinic internist
Sandhya Pruthi, M.D.
read biographyclose windowBiography of
Sandhya Pruthi, M.D.
Sandhya Pruthi, M.D.
Dr. Sandhya Pruthi, certified by the American Board of Family Practice, has been practicing medicine at Mayo Clinic since 1995 with special interests in breast diseases and women's health.
Dr. Pruthi is a consultant in the Department of Medicine, the Division of General Internal Medicine and the Breast Diagnostic Clinic. She is an associate professor of medicine at Mayo Clinic College of Medicine in Rochester, Minn.
The Winnipeg, Manitoba, native is enthusiastic about promoting education and patient-related research and has been active in both areas since joining Mayo Clinic. Dr. Pruthi is the primary investigator at Mayo Clinic of a clinical trial evaluating new agents for the prevention of breast cancer and has research interests in the identification of biomarkers for early detection of breast cancer.
Her other research and clinical interests include managing the health of women who are at increased risk of breast cancer, breast pain and hot flashes, and developing patient education decision-making tools for breast-related concerns.
She is past director of the Breast Diagnostic Clinic and has been a member of the Women's Health Executive Committee. Dr. Pruthi has been newly elected as a secretary of the executive committee for the American Society of Breast Disease. She has assisted with a variety of website content.
"Having an opportunity to share information and empower my patients in the way that will help them to understand and be able to make educated decisions about their own health is very important to me," Dr. Pruthi says.
"The Internet is a tremendous resource and information site for people, and I want them to get up-to-date and accurate information to be able to make informed choices for themselves, their family members and friends."
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Question
HER2-positive breast cancer: What is it?
A friend of mine has HER2-positive breast cancer. Can you tell me what this means?
Answer
from Sandhya Pruthi, M.D.
HER2-positive breast cancer is a breast cancer that tests positive for a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells. In about 1 of every 5 breast cancers, the cancer cells make an excess of HER2 due to a gene mutation. This gene mutation and the elevated levels of HER2 that it causes can occur in many types of cancer — not only breast cancer. This is a gene mutation that occurs only in the cancer cells and is not a type of mutation that you can inherit from a parent.
HER2-positive breast cancers tend to be more aggressive than other types of breast cancer. They're also less responsive to hormone treatment. However, treatments that specifically target HER2 are very effective. They include:
- Trastuzumab (Herceptin). Trastuzumab, which specifically targets HER2, kills these cancer cells and decreases the risk of recurrence. Trastuzumab is often used with chemotherapy. But it may also be used alone or in combination with hormone-blocking medications, such as an aromatase inhibitor or tamoxifen. Trastuzumab is usually well tolerated, but it does have some potential side effects, such as congestive heart failure and allergic reaction.
- Lapatinib (Tykerb). Like trastuzumab, lapatinib is a HER2-specific drug. Lapatinib may be effective for HER2-positive breast cancer that doesn't respond to trastuzumab. Lapatinib is used in combination with the chemotherapy drug capecitabine (Xeloda) and the aromatase inhibitor letrozole (Femara). Lapatinib is also being studied in combination with trastuzumab. Common side effects include rash, loose stools and the potential risk of congestive heart failure.
In addition, there are several new medications being developed that also target HER2 and are being tested in clinical trials.
Standard chemotherapy agents such as doxorubicin (Adriamycin) also can be effective in treating HER2-positive breast cancers, although these drugs don't specifically target the HER2 protein.
Routine testing for HER2 is recommended for most women diagnosed with invasive breast cancer because the results may affect treatment recommendations and decisions. HER2 testing is not done routinely for ductal carcinoma in situ but may be performed as part of a clinical trial. Whenever breast cancer recurs or spreads, the cancer cells should be retested for HER2 as well as for hormone receptor status, as these can change from the original cancer in up to 20 to 30 percent of cases.
- Yamouchi H, et al. HER2 and predicting response to therapy in breast cancer. http://www.uptodate.com/home/index. Accessed March 26, 2012.
- Hayes DF, et al. Systemic treatment for metastatic breast cancer: General principles. http://www.uptodate.com/home/index. Accessed March 26, 2012.
- Pritchard KI, et al. HER2 and responsiveness of breast cancer to adjuvant chemotherapy. The New England Journal of Medicine. 2006;354:2103.
- Herceptin (prescribing information). South San Francisco, Calif.: Genentech, Inc.; 2010. http://www.gene.com/gene/products/information/pdf/herceptin-prescribing.pdf. Accessed March 26, 2012.
- Tykerb (prescribing information). Research Triangle Park, N.C.: GlaxoSmithKline; 2012. http://us.gsk.com/products/assets/us_tykerb.pdf. Accessed March 26, 2012.
- Tumor markers. American Cancer Society. http://www.cancer.org/docroot/PED/content/PED_2_3X_Tumor_Markers.asp. Accessed March 26, 2012.
- Moynihan TJ (expert opinion). Mayo Clinic, Rochester, Minn. March 26, 2012.
- Wolff AC, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor 2 testing in breast cancer. Journal of Clinical Oncology. 2007;25:118.
- Fehm T, et al. Changes of serum HER2 status during clinical course of metastatic breast cancer patients. Anticancer Research. 2004;24:4205.
- Femara (prescribing information). East Hanover, N.J.: Novartis Pharmaceuticals Corporation; 2011. http://www.pharma.us.novartis.com/product/pi/pdf/Femara.pdf. Accessed March 25, 2012.
- FDA expands use of approved breast cancer drug. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm199374.htm. Accessed March 26, 2012.
- Adriamycin (prescribing information). Bedford, Ohio: Ben Venue Laboratories Inc.; 2010. http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing+Information/PIs/Ben+Venue_Bedford+Labs/55390-231-10+ADR+LYO+10MG/5539023110. Accessed March 25, 2012.
- Pruthi S (expert opinion). Mayo Clinic, Rochester, Minn. March 26, 2012.
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