Updates in the Management of HER2-Positive Breast Cancer

Abstract

Introduction: This paper presents a systematic literature review on therapeutic advances in the treatment of HER2-positive breast cancer, focusing on the effectiveness of trastuzumab within the Brazilian Unified Health System (SUS) and on emerging therapies both nationally and internationally. HER2-positive breast cancer accounts for approximately 20% of all breast malignancies and is characterized by clinical aggressiveness and lower survival rates. Objective: The study aims to understand how the introduction of trastuzumab transformed the prognosis of patients, particularly in the public health context, and how new therapies have expanded treatment options. Methodology: The methodology consisted of a review of scientific articles from PubMed and SciELO databases, published in the last five years, focusing on studies discussing treatments with trastuzumab, tyrosine kinase inhibitors, and antibody-drug conjugates in both adjuvant and metastatic settings. Two key studies were highlighted: one Brazilian, which evaluated women treated with adjuvant trastuzumab in a public hospital and found an overall survival rate of 85.9% after nine years; and another international, which analyzed the combination of subcutaneous trastuzumab, pertuzumab, and docetaxel, with a clinical response in over 75% of cases. Results and Discussion: The results reinforce trastuzumab’s positive impact on survival and quality of life and demonstrate good treatment tolerability. The discussion also covers therapies such as trastuzumab deruxtecan and tyrosine kinase inhibitors (TKIs) in refractory cases or brain metastases, expanding the available therapeutic arsenal. Conclusion: It concludes that while innovations bring important clinical benefits, the main challenge remains expanding access to these therapies within SUS. Investments in public policy, early diagnosis, healthcare infrastructure, and professional training are essential to effectively incorporate these technologies and reduce disparities in the treatment of HER2-positive breast cancer in Brazil.