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Frankie Ann Holmes, MD, a physician at Texas Oncology, discusses neoadjuvant duel HER2-directed therapy in breast cancer.
Neoadjuvant directed therapy is seeing extremely high total pathological complete response rates. For patients whose tumors are greater than 2 centimeters or are node-positive, dual anti—HER2-directed therapy with trastuzumab and pertuzumab (Perjeta) either with a taxane carboplatin backbone or, with the anthracycline cytoxin then taxane backbone, have shown to be very effective and are the optimal choices of therapy for those patients, said Holmes.
Patients that are ER-negative that have the HER-enriched phenotype have much more aggressive disease and may need the duel HER2-targeted therapy, while patients with more Luminal disease may not, said Holmes. Questions still remain regarding treatment for patients that do not meet the criteria for duel HER2-directed therapy.
Biomarkers will need to be discovered to determine which patients need maximum therapy, which comes with additional costs and toxicities, and which ones do not, she said.