Dr. Murthy on De-Escalation Strategies in HER2-Positive Breast Cancer

Rashmi K. Murthy, MD
Published: Wednesday, Sep 05, 2018



Rashmi K. Murthy, MD, assistant professor, Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses de-escalation strategies for patients with HER2-positive breast cancer.

In addition to a potentially shorter duration of trastuzumab (Herceptin), other strategies that have been evaluated include looking at less toxic regimens, says Murthy. For example, it has been shown that patients with node-negative, HER2-positive breast cancer benefit from paclitaxel and trastuzumab in the adjuvant setting. Additionally, the KRISTINE study randomized patients to docetaxel, carboplatin, trastuzumab, and pertuzumab (Perjeta) versus T-DM1 (ado-trastuzumab emtansine; Kadcyla) plus pertuzumab. Although the chemotherapy-containing arm did better in terms of pathological complete response, patients who did not receive chemotherapy still had a robust pathological response and seemed to benefit from a toxicity profile perspective, states Murthy.

However, physicians need to gain a better understanding of who can benefit from a chemotherapy-free regimen. Though chemotherapy-free regimens have yet to be established as a standard of care, it is an area worth exploring, notes Murthy.


Rashmi K. Murthy, MD, assistant professor, Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses de-escalation strategies for patients with HER2-positive breast cancer.

In addition to a potentially shorter duration of trastuzumab (Herceptin), other strategies that have been evaluated include looking at less toxic regimens, says Murthy. For example, it has been shown that patients with node-negative, HER2-positive breast cancer benefit from paclitaxel and trastuzumab in the adjuvant setting. Additionally, the KRISTINE study randomized patients to docetaxel, carboplatin, trastuzumab, and pertuzumab (Perjeta) versus T-DM1 (ado-trastuzumab emtansine; Kadcyla) plus pertuzumab. Although the chemotherapy-containing arm did better in terms of pathological complete response, patients who did not receive chemotherapy still had a robust pathological response and seemed to benefit from a toxicity profile perspective, states Murthy.

However, physicians need to gain a better understanding of who can benefit from a chemotherapy-free regimen. Though chemotherapy-free regimens have yet to be established as a standard of care, it is an area worth exploring, notes Murthy.



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