HER2-Positive Early Breast Cancer: Applying DESTINY-Breast11 in Clinical Practice

Dr. Neil Iyengar continues the discussion on HER2-positive early breast cancer by exploring how the DESTINY-Breast11 findings may translate into routine clinical practice. Dr. Alison Conlin and Dr. Kelly McCann discuss the relevance of historical studies, including anthracycline-sparing approaches, and compare pathologic complete response rates observed across trials. The faculty consider whether the control arm used in DESTINY-Breast11 reflects contemporary practice and examine how clinicians may adapt the study findings when selecting neoadjuvant therapy for high-risk patients. They also discuss the concept of response-adapted treatment strategies, including the potential role of initiating standard HER2-directed therapy before escalating treatment based on response, while acknowledging that this approach was not evaluated in the trial. The conversation highlights the challenges of integrating emerging evidence into clinical decision-making and emphasizes the importance of individualized treatment planning for patients with high-risk HER2-positive early breast cancer.