Dr. Hurvitz on Treatment Options in Early-Stage HER2+ Breast Cancer

Sara A. Hurvitz, MD, associate professor at the David Geffen School of Medicine, University of California, Los Angeles (UCLA) medical director of the Jonsson Comprehensive Cancer Center Clinical Research Unit, co-director of the Santa Monica-UCLA Outpatient Oncology Practices, and director, Breast Cancer Clinical Trials Program, UCLA, discusses available treatment options in early-stage HER2-positive breast cancer.

The treatment landscape in early-stage HER2-positive breast cancer has evolved with multiple novel agents, says Hurvitz.

Notably, neoadjuvant therapy has become more widespread. The combination of trastuzumab (Herceptin), pertuzumab (Perjeta), docetaxel and carboplatin (TCHP) can be used as neoadjuvant therapy for patients with early-stage HER2-positive disease whose tumors are ≥15 mm or are node-positive, explains Hurvitz. TCHP has an improved safety profile compared with an anthracycline-based regimen.

Following 6 cycles of TCHP, patients will undergo surgery, says Hurvitz. Patients who achieve a pathologic complete response should complete 1 full year of trastuzumab. Patients who had node-positive disease at baseline should also complete complete 1 full year of pertuzumab.

Neratinib (Nerlynx) and ado-trastuzumab emtansine (T-DM1; Kadcyla) are also FDA approved options in the adjuvant setting. Neratinib is indicated for the extended adjuvant treatment of patients with early-stage HER2-positive breast cancer while T-DM1 is approved for the adjuvant treatment of patients who have residual invasive disease after neoadjuvant trastuzumab and chemotherapy.