Dr. Hurvitz Discusses De-Escalation in HER2+ Breast Cancer

Sara A. Hurvitz, MD, director of the Breast Oncology Program at the University of California, Los Angeles, Jonsson Comprehensive Cancer Center, discusses de-escalation in HER2-positive breast cancer.

It is difficult to distinguish which patients should receive traditional therapy from those who would benefit from a de-escalation of therapy, says Hurvitz. Hurvitz recommends that a 32-year-old patient with a very high-grade 1.2-cm tumor and lymphovascular invasion that is HER2-positive and estrogen receptor- and progesterone receptor-negative should undergo a more traditional approach supported by phase III evidence.

On the other hand, de-escalation may be a better option for a patient with HER2-positive breast cancer with hormone receptor co-expression in the tumor. Low- and intermediate-grade tumors, and lack of lymphovascular invasion are also indicators that de-escalation may be a safe route, but Hurvitz warns that this isn’t an exact science. Biomarkers are being looked to in clinical trials of de-escalation to better select patients.