Case Study: Treating HER2-Positive MBC, Part II

Panelists: Adam M. Brufsky, MD, PhD, University of Pittsburgh; Sara Hurvitz, MD, UCLA;
Joyce A. O'Shaughnessy, MD, US Oncology; Edith A. Perez, MD, Mayo Clinic; Hope S. Rugo, MD, UCSF;
Andrew D. Seidman, MD, MSKCC
Published Online: Tuesday, August 20, 2013
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In the continuation of a case-based discussion, the panel reviews clinical trials looking at potential treatment strategies for a 59 year-old woman with metastatic breast cancer (MBC). In the case study, the patient was diagnosed with ER and HER2-positive MBC and received adjuvant Adriamycin plus Cytoxan followed by paclitaxel with trastuzumab and 5 years of anastrozole. After 8 years, the patient recurred with pulmonary and liver metastases.

Andrew D. Seidman, MD, comments that the treatment recommended by Sara Hurvitz, MD, in part I was provocative and counterintuitive. In this segment, Hurvitz recommended administering a taxane with pertuzumab and trastuzumab in the frontline followed by HER2-targeted therapies alone with the potential to add an endocrine therapy. More data will be available on this treatment approach from the phase II PERTAIN trial, Seidman notes.

In regard to the chemotherapy utilized, Seidman references the HERNATA trial that compared trastuzumab plus docetaxel or vinorelbine as a frontline treatment for HER2-positive MBC. In this trial, both treatment approaches resulted in similar efficacy with significantly less toxicity in the vinorelbine arm, notes Edith A. Perez, MD.

Building off the HERNATA and CLEOPATRA trial, the phase II VELVET trial is exploring the combination of pertuzumab, trastuzumab, and vinorelbine for the first-line treatment of patients with HER2-positive MBC, Perez notes. In the first cohort of the trial, each treatment will be administered sequentially. In the second cohort, vinorelbine will be followed by simultaneous trastuzumab and pertuzumab. Results from the first cohort are expected to be presented at the 2013 San Antonio Breast Cancer Symposium.

In regard to chemotherapy, remarks Hope S. Rugo, MD, one nice thing about vinorelbine is the lack of alopecia. However, it is important to monitor gastrointestinal toxicities. Another treatment option, if approved in this space, could be treatment with T-DM1, Rugo suggests.

View More From This Discussion
Episode 1 Introduction and Exploration of Fulvestrant in Breast Cancer
Episode 2 Combination of Anastrozole and Fulvestrant in MBC
Episode 3 BOLERO-2 Trial: Everolimus in Metastatic Breast Cancer
Episode 4 Management of mTOR Inhibitor Side Effects in Breast Cancer
Episode 5 EMILIA Trial: T-DM1 in Metastatic Breast Cancer
Episode 6 Frontline T-DM1 in HER2+ Metastatic Breast Cancer
Episode 7 CLEOPATRA Trial: Frontline Pertuzumab for HER2+ MBC
Episode 8 MA.31 Trial: Taxane With Lapatinib or Trastuzumab
Episode 9 Treatment With Eribulin in Metastatic Breast Cancer
Episode 10 Case Study: Treating HER2-Positive MBC, Part I
Episode 11 Case Study: Treating HER2-Positive MBC, Part II
Episode 12 Paclitaxel With Pertuzumab Plus Trastuzumab in MBC
Episode 13 Case Study: Treating HR+ and HER2- Breast Cancer
Episode 14 Managing Bone Health in Metastatic Breast Cancer
Episode 15 Surgical Removal of Primary Tumors in Stage IV MBC
Episode 16 Case Study: Metastatic Triple-Negative Breast Cancer
Episode 17 Personalized Medicine in Triple-Negative Breast Cancer
Episode 18 Conclusion and Final Thoughts on Managing Breast Cancer
Expert Panelists
Dr Adam Brufsky

Adam M. Brufsky, MD, PhD

Professor of Medicine, University of Pittsburgh
Medical Director of the Women’s Cancer Center
at Magee-Womens Hospital of UPMC
and the University of Pittsburgh Cancer Institute
Pittsburgh, Pennsylvania

Sara Hurvitz, MD

Assistant Professor & Director,
Hematology/Oncology Breast Cancer Program, UCLA's Jonsson Comprehensive Cancer Center, Los Angeles, California

Joyce A. O’Shaughnessy, MD

Co-Director, Breast Cancer Research
Baylor Charles A. Sammons Cancer Center
Texas Oncology, PA/US Oncology,
Dallas, Texas

Edith A. Perez, MD

Deputy Director of the Mayo Clinic Cancer Center, Director of the Breast Cancer Translational Genomics Program and the Breast Program at Mayo Clinic,
Jacksonville, Florida

Hope S. Rugo, MD

Professor of Medicine and Director of the Breast Oncology, Clinical Trials, and Education Program, University of California San Francisco Comprehensive Cancer Center, San Francisco, California

Andrew D. Seidman, MD

Professor of Medicine, Weill Cornell Cancer Center, Attending Physician at Memorial Sloan Kettering Cancer Center,
New York, New York
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