Dr. Ali on Choosing Adjuvant Treatment for HER2+ Breast Cancer

Haythem Y. Ali, MD
Published: Friday, May 18, 2018



Haythem Y. Ali, MD, senior medical oncologist, Henry Ford Hospital, discusses the adjuvant treatment of patients with HER2-positive breast cancer.

In July 2017, the FDA approved neratinib (Nerlynx) for the extended adjuvant treatment of patients with early stage, HER2-positive breast cancer following postoperative trastuzumab (Herceptin). Following this approval, the FDA approved pertuzumab (Perjeta) in combination with trastuzumab and chemotherapy as an adjuvant treatment for patients with HER2-positive early breast cancer at high risk for recurrence in December 2017.

Clinicians can now choose between 2 adjuvant therapeutic regimens—trastuzumab plus pertuzumab, or neratinib. Both of these are dose-escalation strategies, says Ali, so clinicians should focus on patients who will benefit the most. Focusing on higher-risk patients, the small amount of benefit that adjuvant therapy provides is more impactful, he explains. The question is, which high-risk patients receive which dosage strategy? The subgroup analyses from these trials may help clinicians make their decision, Ali says.


Haythem Y. Ali, MD, senior medical oncologist, Henry Ford Hospital, discusses the adjuvant treatment of patients with HER2-positive breast cancer.

In July 2017, the FDA approved neratinib (Nerlynx) for the extended adjuvant treatment of patients with early stage, HER2-positive breast cancer following postoperative trastuzumab (Herceptin). Following this approval, the FDA approved pertuzumab (Perjeta) in combination with trastuzumab and chemotherapy as an adjuvant treatment for patients with HER2-positive early breast cancer at high risk for recurrence in December 2017.

Clinicians can now choose between 2 adjuvant therapeutic regimens—trastuzumab plus pertuzumab, or neratinib. Both of these are dose-escalation strategies, says Ali, so clinicians should focus on patients who will benefit the most. Focusing on higher-risk patients, the small amount of benefit that adjuvant therapy provides is more impactful, he explains. The question is, which high-risk patients receive which dosage strategy? The subgroup analyses from these trials may help clinicians make their decision, Ali says.

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