Sunil Verma, MD medical director of the Tom Baker Cancer Centre and professor and head of the Department of Oncology at the University of Calgary, discusses how findings from the MA.31 trial—which looked at lapatinib (Tykerb) versus trastuzumab (Herceptin) in HER2-positive patients with metastatic breast cancer— can be applied to the early-stage setting.
The MA.31 trial showed that taxanes plus trastuzumab were better than taxanes plus lapatinib. Similar findings were seen in the neoadjuvant and adjuvant setting. This shows that evidence can be translated into the early breast cancer setting, as well, says Verma.
For the current neoadjuvant treatment for early HER2-positive breast cancer, chemotherapy plus anti-HER2 treatment is given. Now, the FDA has approved pertuzumab for 3 to 6 cycles in the neoadjuvant setting and that has been incorporated in the United States.
In certain patients, chemotherapy can be de-escalated when given with weekly paclitaxel and trastuzumab therapy. Right now, in the neoadjuvant setting, researchers are trying to balance for which patients therapy can be de-escalated and which patients need to receive all of the therapies.