HER2 splice variants in breast cancer: investigating their impact on diagnosis and treatment outcomes

Vic Hart _, Hannah Gautrey, John Kirby and Alison Tyson-Capper

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Oncotarget. 2020; 11:4338-4357. https://doi.org/10.18632/oncotarget.27789

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Vic Hart1, Hannah Gautrey1, John Kirby1 and Alison Tyson-Capper1

1 Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK

Correspondence to:

Alison Tyson-Capper,email: [email protected]

Keywords: HER2; Δ16-HER2; splice variant; breast cancer; trastuzumab

Received: June 17, 2020     Accepted: October 10, 2020     Published: November 17, 2020

Copyright: © 2020 Hart et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Overexpression of the HER2 receptor occurs in approximately 20% of breast cancer patients. HER2 positivity is associated with poor prognosis and aggressive tumour phenotypes, which led to rapid progress in HER2 targeted therapeutics and diagnostic testing. Whilst these advances have greatly increased patients’ chances of survival, resistance to HER2 targeted therapies, be that intrinsic or acquired, remains a problem.

Different forms of the HER2 protein exist within tumours in tandem and can display altered biological activities. Interest in HER2 variants in breast cancer increased when links between resistance to anti-HER2 therapies and a particular variant, Δ16-HER2, were identified. Moreover, the P100 variant potentially reduces the efficacy of the anti-HER2 therapy trastuzumab. Another variant, Herstatin, exhibits ‘auto-inhibitory’ behaviour. More recently, new HER2 variants have been identified and are currently being assessed for their pro- and anti-cancer properties.

It is important when directing the care of patients to consider HER2 variants collectively. This review considers HER2 variants in the context of the tumour environment where multiple variants are co-expressed at altered ratios. This study also provides an up to date account of the landscape of HER2 variants and links this to patterns of resistance against HER2 therapies and treatment plans.

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