Erika P. Hamilton, MD, director of the Breast and Gynecologic Research Program at Sarah Cannon Research Institute, discusses adjuvant therapy for the treatment of patients with HER2-positive breast cancer.
There is a lot of decision-making left to be done in this paradigm, Hamilton says. First and foremost, recent research has underscored the importance of giving neoadjuvant therapy to this patient population. This was well-defined when pertuzumab (Perjeta) was only indicated in the neoadjuvant setting, but Hamilton says physicians became a little more lax about trying to catch patients before surgery once the HER2-targeted agent was approved in the adjuvant setting.
Investigators need a better criteria for deciding which patients need additional therapy after surgery, Hamilton notes. In terms of adjuvant neratinib (Nerlynx), this drug seems to have more benefit in patients in hormone receptor—positive, HER2-positive breast cancer compared with those who are hormone receptor–negative, HER2-positive, she adds. There appears to be widespread benefit from pertuzumab, but an unanswered question is whether or not patients who received this drug neoadjuvantly should receive it again in the adjuvant setting.
Hamilton adds that data from the KATHERINE study was compelling in that investigators effectively defined a specific subset of patients who need adjuvant therapy with ado-trastuzumab emtansine (T-DM1; Kadcyla): patients who received standard chemotherapy in the neoadjuvant setting and did not achieve a pathologic complete response (PCR). Hamilton adds that data from the trial suggested that patients with estrogen receptor—positive disease are likely to achieve a PCR.