Exciting New Options Emerge for HER2-Positive Breast Cancer

Christin L. Melton, ELS
Published: Wednesday, Mar 18, 2020
Debu Tripathy, MD, Professor and Chairman Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center

Debu Tripathy, MD

The introduction of trastuzumab (Herceptin) more than 20 years ago transformed survival expectations for patients with HER2-positive breast cancer, especially for those with early-stage disease.1 HER2-positive breast cancer is aggressive, however, and the prognosis for patients with advanced disease at diagnosis or for those who are resistant to trastuzumab-based regimens remains poor.1,2 During a recent OncLive Peer Exchange®, experts in breast cancer research expressed optimism that new therapies would improve outcomes for patients with this challenging disease.

Table. Novel Therapies for Patients With HER2-Positive Advanced Disease2,15-19 (Click to Enlarge)

Joyce A. O’Shaughnessy, MD, said that although the OS hazard ratio of 0.85 in the pertuzumab arm was not significant, it was “trending in the right direction.” OS data were still immature at the time of presentation. For the primary end point of invasive disease-free survival (iDFS), updated 6-year data showed a difference of 2.8% between the pertuzumab and placebo arms (90.6% vs 87.8%, respectively; HR, 0.76).10 O’Shaughnessy said that whereas 3-year iDFS rates showed patients with hormone receptor–negative disease derived greater benefit from pertuzumab than those with hormone receptor–positive disease, updated rates showed both groups benefited.

The 6-year results showed that patients with node-positive but not node-negative disease benefited from pertuzumab (iDFS HR, 0.73 vs 0.83, respectively).10

O’Shaughnessy said the findings complicate treatment decisions because when pertuzumab is administered as part of neoadjuvant therapy, the FDA label calls for continuing pertuzumab as adjuvant therapy for up to 18 cycles.11 O’Shaughnessy asked the panel: “If somebody is clinically node-negative…do we use preoperative pertuzumab? If patients have T2 or above, but then they have a pCR and you don’t see any fibrosis in the lymph node, do you continue with the full year of trastuzumab and pertuzumab, or do you just go with trastuzumab?”

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