Ian E. Krop, MD, PhD, discusses the role of neratinib as extended adjuvant therapy in high-risk, hormone receptor–positive, HER2-positive breast cancer.
Ian E. Krop, MD, PhD, an associate professor of medicine, Harvard Medical School, associate chief, Division of Breast Oncology, Susan F. Smith Center for Women's Cancers, medical oncologist and clinical research director, Breast Oncology Center, Dana-Farber Cancer Institute, discusses the role of neratinib (Nerlynx) as extended adjuvant therapy in high-risk, hormone receptor (HR)–positive, HER2-positive breast cancer.
Currently, neratinib is used as extended adjuvant therapy in patients with HR-positive, HER2-positive breast cancer, says Krop.
However, pertuzumab (Perjeta) has clouded the utility of neratinib, says Krop. Patients enrolled in the phase 3 ExteNET study, whichdemonstrated benefit with neratinib as extended adjuvant therapy in patients with HER2-positive disease, had not received prior pertuzumab.
Further, adding ado-trastuzumab emtansine (T-DM1; Kadcyla) to the armamentarium further complicates treatment selection, Krop explains.
Additionally, as shown in the phase 3 KATHERINE trial, a large proportion of high-risk patients who have multiple positive lymph nodesprogress on T-DM1, Krop adds.
As such, in high-risk patients with HR-positive, HER2-positive disease, neratinib should be considered as extended adjuvant therapy. However, this treatment decision is more challenging to justify in the lower-risk patient populations, Krop concludes.