Dr. Murthy on De-Escalation Strategies in HER2-Positive Breast Cancer

Rashmi K. Murthy, MD, assistant professor, Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses de-escalation strategies for patients with HER2-positive breast cancer.

In addition to a potentially shorter duration of trastuzumab (Herceptin), other strategies that have been evaluated include looking at less toxic regimens, says Murthy. For example, it has been shown that patients with node-negative, HER2-positive breast cancer benefit from paclitaxel and trastuzumab in the adjuvant setting. Additionally, the KRISTINE study randomized patients to docetaxel, carboplatin, trastuzumab, and pertuzumab (Perjeta) versus T-DM1 (ado-trastuzumab emtansine; Kadcyla) plus pertuzumab. Although the chemotherapy-containing arm did better in terms of pathological complete response, patients who did not receive chemotherapy still had a robust pathological response and seemed to benefit from a toxicity profile perspective, states Murthy.

However, physicians need to gain a better understanding of who can benefit from a chemotherapy-free regimen. Though chemotherapy-free regimens have yet to be established as a standard of care, it is an area worth exploring, notes Murthy.