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Dr. Chien on De-Escalation Strategies for Patients With HER2-Positive Breast Cancer

A. Jo Chien, MD
Published: Saturday, Oct 27, 2018



A. Jo Chien, MD, associate clinical professor, Department of Medicine, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses de-escalation strategies for patients with HER2-positive breast cancer.

The first approach is looking at de-escalating chemotherapy, says Chien. Physicians used to give aggressive regimens containing anthracyclines. Though the BCIRG 006 study was not powered to look at this, physicians saw very similar long-term outcomes out to 10 years between non-anthracycline and anthracycline-based chemotherapies. In the APT study in patients with stage I node-negative tumors, physicians saw long-term outcomes with disease-free survival rates of 94% at 7 years of follow-up.

Another approach is looking at the duration of trastuzumab (Herceptin). Physicians know that patients do not benefit from more than 1 year of trastuzumab, but because 1 year was chosen arbitrarily, it may be worth investigating lower durations, explains Chien. Moreover, giving just hormone therapy with either trastuzumab or a small molecule tyrosine kinase inhibitor is being investigated, as a subset of those patients will achieve complete responses without chemotherapy.


A. Jo Chien, MD, associate clinical professor, Department of Medicine, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses de-escalation strategies for patients with HER2-positive breast cancer.

The first approach is looking at de-escalating chemotherapy, says Chien. Physicians used to give aggressive regimens containing anthracyclines. Though the BCIRG 006 study was not powered to look at this, physicians saw very similar long-term outcomes out to 10 years between non-anthracycline and anthracycline-based chemotherapies. In the APT study in patients with stage I node-negative tumors, physicians saw long-term outcomes with disease-free survival rates of 94% at 7 years of follow-up.

Another approach is looking at the duration of trastuzumab (Herceptin). Physicians know that patients do not benefit from more than 1 year of trastuzumab, but because 1 year was chosen arbitrarily, it may be worth investigating lower durations, explains Chien. Moreover, giving just hormone therapy with either trastuzumab or a small molecule tyrosine kinase inhibitor is being investigated, as a subset of those patients will achieve complete responses without chemotherapy.



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