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How Long Does Maintenance Therapy Last for HER2-Positive Breast Cancer?

Posted on September 01, 2022
Medically reviewed by
Todd Gersten, M.D.
Article written by
Emery Haley, Ph.D.

  • Maintenance therapy is given to help prevent breast cancer from returning after initial treatment.
  • Maintenance therapy for HER2-positive breast cancer is taken long term, for months or years, but just how long depends on your cancer’s stage and response to initial treatments.
  • Nurses are a key part of your breast cancer treatment team and can provide support during maintenance treatment

MyBCTeam members often celebrate finishing their initial chemotherapy regimens and beginning maintenance therapy. “Congrats on getting the chemo done!” offered one member to another. “The maintenance treatments go so much faster, and you will start getting more of your energy back.”

In HER2-positive breast cancer, cancer cells make large amounts of a protein called human epidermal growth factor receptor 2 (HER2). This type of breast cancer requires HER2 to continue growing, so it’s vulnerable to treatments that target this protein.

HER2-positive breast cancer has a high risk of recurrence (coming back) and metastasis (spreading to other parts of the body). But new targeted maintenance treatments have extended both progression-free survival (time until cancer worsens) and overall survival (how long a person lives). This means that it’s critical to stick with your maintenance therapy to get the best results from your treatment. Your whole breast cancer care team, including your medical oncologist, nurse navigator, and oncology treatment nurse, is there to support you through this important phase of treatment.

People starting maintenance therapy for HER2-positive breast cancer naturally have questions about how long this phase of treatment will last and what to expect.

What Is Maintenance Therapy?

Maintenance therapy is given to help keep cancer that disappeared after initial therapy from coming back. Initial treatment for HER2-positive breast cancer may include:

  • Chemotherapy
  • Radiotherapy
  • Surgery

Regardless of your stage at diagnosis, your oncology care team will likely recommend starting maintenance therapy right after your initial treatment. Maintenance therapy may simply mean continuing one or two medications that you took for your first treatment.

The goal of maintenance therapy is to maintain remission — to prevent or delay the cancer’s return. Complete remission (also called complete response) means that after treatment, no signs of cancer remain.

Sometimes, cancer reaches partial remission (partial response), which means that treatment reduced the tumor’s size or the cancer’s spread but did not kill all the cancer cells. In this case, maintenance therapy is also called “continuous therapy” because it is used continuously to keep cancer from progressing. Another goal of continuous maintenance therapy is to minimize the use of chemotherapy.

How Is Maintenance Therapy Given?

Maintenance therapy for HER2-positive breast cancer usually means taking at least one targeted drug designed to block the activity of the HER2 protein. The most common of these medications are trastuzumab (Herceptin) and pertuzumab (Perjeta). Both medications are anti-HER2 monoclonal antibodies, a type of laboratory-made protein that recognizes HER2 and stops it from sending growth signals to the cancer cells. These drugs are commonly combined.

Targeted medications can be given through either IV infusion into a vein or an injection under the skin. IV infusions can take hours, whereas injections are delivered more quickly. Both infusions and injections need to be given by an oncology treatment nurse, usually at an infusion center, but sometimes a nurse can do the injection at your home. Both the IV and injected forms are typically given once every three weeks. Your oncology nurse can help answer questions related to treatment administration.

Nurses Are Key

Nurses are a vital part of your breast cancer care team and perform many important roles. Nurse navigators can help you navigate a new diagnosis, make appointments, and help you access other services you may require. Oncology treatment nurses administer maintenance treatments and provide support. Nurses can also answer many of your questions about maintenance therapy.

HER2-Positive and Hormone Receptor-Positive Breast Cancer

Some breast cancers that are positive for HER2 are also positive for proteins called hormone receptors. Hormone receptor-positive (HR-positive) cancers include estrogen receptor-positive and progesterone receptor-positive cancers. About half of HER2-positive breast cancers are also HR-positive.

Additional maintenance therapy options that may be recommended for this HR-positive subgroup include neratinib (Nerlynx), a kinase inhibitor pill taken once a day, and endocrine therapy, a hormone-targeted therapy given as a daily pill for up to 10 years. Endocrine therapy may be recommended instead of trastuzumab or combined with it.

How Long Do You Need To Take Maintenance Therapy?

Maintenance therapy is taken long term, but exactly how long depends on the severity or stage of your cancer.

Early-Stage Breast Cancer

For cases of breast cancer in stages 0 through 3, maintenance treatment is usually given after a chemotherapy regimen such as paclitaxel (Taxol). After the final dose of chemotherapy, maintenance therapy is typically continued for another six months, for a total of 12 months.

A meta-analysis of five studies with more than 12,000 participants found that stopping trastuzumab maintenance therapy after one year was safer than stopping after six months. Taking trastuzumab maintenance therapy for longer than one year, however, was associated with increased cardiotoxicity, or damage to the heart, a rare but serious side effect of trastuzumab. Talk to your oncology care nurse if you have any concerns about your risk for heart problems during maintenance treatment.

Advanced or Metastatic Breast Cancer

According to the American Society of Clinical Oncology (ASCO) guidelines, maintenance therapy is a lifelong treatment for advanced or metastatic breast cancer. If the cancer progresses, you and your doctor will discuss switching treatments. If side effects become difficult to manage, talk to your oncology nurse about options.

Checking In With Your Health Care Team

To minimize the risk of congestive heart failure associated with trastuzumab, your doctor may want to do routine tests that check your heart function. This is especially important if you smoke or have a preexisting heart condition. If you are taking certain endocrine therapies, which may contribute to bone loss, you may also need bone density testing. You can ask your nurse navigator for help scheduling this testing.

How often you’ll need to follow up with your doctor or oncology nurse depends on the stage of your cancer, what treatments you are getting, and how well your cancer is responding.

Complete Remission

A person in complete remission may continue to have follow-up visits with their oncologist or cancer care nurse. Yearly mammography is the only screening that ASCO and the American College of Physicians recommend for people in complete remission with no new or returning symptoms.

Partial Remission

A person in partial remission or with new or returning symptoms of cancer will need more frequent follow-ups. Doctors will look for new or remaining tumors and determine where they are located and how they are responding to treatment. People who have just completed treatments will also have more frequent follow-ups for the next five years.

Talk with your doctor or nurse if you have symptoms that suggest your cancer may have returned, such as:

  • A new lump
  • New or different pain, often involving the bones
  • Lack of energy
  • Shortness of breath

The same types of tests used to initially diagnose breast cancer — such as imaging tests, blood tests for tumor markers, and biopsy — may be done to confirm whether the cancer is back. Always speak with your oncology care team about your symptoms, treatment side effects, and concerns. Your oncology care team can discuss your treatment options and work with you to decide on the best treatment for you.

Talk With Others Who Understand

On MyBCTeam, the social network for people with breast cancer and their loved ones, more than 58,000 members come together to ask questions, give advice, and share their stories with others who understand life with breast cancer.

Are you or a loved one living with HER2-positive breast cancer? Is maintenance therapy part of your treatment plan? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Maintenance Therapy — National Cancer Institute
  2. What Is Maintenance Therapy? — Cancer.Net
  3. Complete Remission — National Cancer Institute
  4. Partial Remission — National Cancer Institute
  5. HER2+ Breast Cancer and the Role of Maintenance Therapies — CancerNetwork
  6. The Changing Paradigm for the Treatment of HER2-Positive Breast Cancer — Cancers
  7. Adjuvant Pertuzumab and Trastuzumab in Early HER2-Positive Breast Cancer — The New England Journal of Medicine
  8. Highlights of Prescribing Information — Phesgo — U.S. Food and Drug Administration
  9. Preference for the Fixed-Dose Combination of Pertuzumab and Trastuzumab for Subcutaneous Injection in Patients With HER2-Positive Early Breast Cancer (PHranceSCa): A Randomised, Open-label Phase II Study — European Journal of Cancer
  10. FDA Approves Breast Cancer Treatment That Can Be Administered at Home by Health Care Professional — U.S. Food and Drug Administration
  11. Adjuvant Endocrine Therapy in HER2-Positive Breast Cancer Patients: Systematic Review and Meta-Analysis — ESMO Open
  12. Neratinib (Oral Route) — Mayo Clinic
  13. Highlights of Prescribing Information — Nerlynx — U.S. Food and Drug Administration
  14. Hormone Therapy for Breast Cancer — Mayo Clinic
  15. Neratinib Is Approved: Should We Reject It Anyway? — The ASCO Post
  16. The Role of Maintenance Therapy in HER2+ Breast Cancer — Cancer Network
  17. Optimal Duration of Adjuvant Trastuzumab in Treatment of Early Breast Cancer: A Meta-Analysis of Randomized Controlled Trials — Breast Cancer Research and Treatment
  18. ASCO Clinical Practice Guideline Update: Systemic Therapy for Patients With Advanced HER2-Positive Breast Cancer — The ASCO Post
  19. Patients Who Achieved Long-Term Clinical Complete Response and Subsequently Terminated Multidisciplinary and Anti-HER2 Therapy for Metastatic Breast Cancer: A Case Series — International Journal of Surgery Case Reports
  20. Bone Density Screening in Postmenopausal Women With Early-Stage Breast Cancer Treated With Aromatase Inhibitors — JCO Oncology Practice
  21. Follow-Up Care After Breast Cancer Treatment — American Cancer Society
  22. Surveillance and Monitoring in Breast Cancer Survivors: Maximizing Benefit and Minimizing Harm — American Society of Clinical Oncology Educational Book
  23. Cardiac Surveillance Guidelines for Trastuzumab-Containing Therapy in Early-Stage Breast Cancer: Getting to the Heart of the Matter — Journal of Clinical Oncology
  24. Cardiotoxicity During Long-Term Trastuzumab Use in Patients With HER2-Positive Metastatic Breast Cancer: Who Needs Cardiac Monitoring? — Epidemiology
All updates must be accompanied by text or a picture.
Todd Gersten, M.D. is a hematologist-oncologist at the Florida Cancer Specialists & Research Institute in Wellington, Florida. Review provided by VeriMed Healthcare Network. Learn more about him here.
Emery Haley, Ph.D. is a nonbinary science communicator with a passion for diversity, equity, and inclusion in STEM. Learn more about them here.

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