Adjuvant Therapy Options in HER2+ eBC and Clinical Data on the PH Regimen

EP: 1.HER2+ Early Breast Cancer: Treatment Optimization and Review of Standard-of-Care Neoadjuvant Regimens

EP: 2.Neoadjuvant Systemic Therapy for HER2+ eBC: Clinical Considerations and Evolving Modalities

EP: 3.How Does Response to Neoadjuvant Therapy Affect Prognosis and Inform Adjuvant Selection?

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EP: 4.Adjuvant Therapy Options in HER2+ eBC and Clinical Data on the PH Regimen

EP: 5.Identifying Patients Suitable for Adjuvant Neratinib

EP: 6.Data Updates and Ongoing Trials in the HER2+ Adjuvant Space

EP: 7.Standard-of-Care and Emerging Therapies for First-line Treatment of HER2+ mBC

EP: 8.Use of ADCs in the Second-Line Treatment of HER2+ mBC

EP: 9.Ongoing Second-Line Trials in Patients with HER2+ mBC and Expert Clinical Perspective

EP: 10.Remaining Unmet Needs in the Third-Line and Lessons from HER2CLIMB

EP: 11.T-DXd: Updated Results from the DESTINY-Breast Studies and Practical Considerations for Followup

EP: 12.HER2+ mBC: Emerging Agents in the Third-Line and Higher Setting

EP: 13.Typical Approaches for Treatment Selection in the Third Line and Beyond

EP: 14.Patient Profile 1: Early Stage HER2+/HR+ BC

EP: 15.Patient Profile 2: Early Stage HER2+/HR- BC

EP: 16.Patient Profile 3: Metastatic HER2+ BC

EP: 17.The Future of HER2+ Breast Cancer Treatment

Transcript:

Sara Hurvitz, MD: Back to what we’re using in clinical practice. Virginia, take us through our standard of care, based on NCCN [National Comprehensive Cancer Network] Guidelines. What should we be doing in the adjuvant setting?

Virginia G. Kaklamani, MD, DSc: Assuming a patient hasn’t received neoadjuvant therapy and they’re coming in after surgery, the NCCN Guidelines are relatively vague as to whether to give trastuzumab-based chemotherapy in small tumors. But they say we should consider it for T1a and T1b disease. This is based on data coming from the Netherlands looking at a prospective cohort of patients, [where the] T1b patients receiving trastuzumab have better outcomes. There was a suggestion that T1a patients also did.

I consider that when I talk to my patients. I recommend it for my patients with T1b disease, and I discuss it with my patients with T1a. For T1c, adjuvant trastuzumab-based chemotherapy is considered standard. Most of us will use the APT [adjuvant paclitaxel-trastuzumab] regimen with weekly paclitaxel and a year of trastuzumab. NCCN guidelines say we should then consider pertuzumab in N1 tumors, which is important. Also, in HER [human epidermal growth factor receptor 2]–positive higher-risk tumors, consider neratinib as well for extended endocrine therapy.

Sara Hurvitz, MD: That sounds good. That’s very clear. Melinda, let’s dive a little deeper into the use of pertuzumab and the data supporting the use of pertuzumab.

Melinda L. Telli, MD: This was an interesting story in breast cancer because the drug got approved about 10 years ago in the preoperative setting. It was an accelerated approval based on phase 2 trials showing increase in the rate of pCR [pathologic complete response] with the addition of pertuzumab to chemotherapy and trastuzumab. A few years later, we finally saw the approval of pertuzumab in the adjuvant setting. Initially it was somewhat unclear which patients were going to benefit.

APHINITY was a large, very standard adjuvant study. It’s the kind of study we don’t see too much anymore. Patients had surgery up front. [There were] nearly 5000 patients, and they had the choice of an anthracycline-taxane-based chemotherapy backbone with trastuzumab or the docetaxel-carboplatin regimen with trastuzumab. They were randomized to receive pertuzumab or not. When the study was first reported, there was a small benefit in invasive disease-free survival of about 1.6%. It has been subsequently updated at the 6-year time point and most recently at the 8-year time point, showing that there’s just under a 3% benefit in the overall population. It approaches 5% in the lymph node–positive [population]. At this point, there isn’t any impact on overall survival. It’s an invasive disease-free survival benefit and supports the use in node-positive disease.

Transcript edited for clarity.