HER2-Positive Early Breast Cancer: Managing Toxicity and Individualizing Neoadjuvant Therapy

Dr. Neil Iyengar leads a discussion with Dr. Kelly McCann and Dr. Alison Conlin on balancing efficacy with safety when incorporating newer therapies into the management of HER2-positive early breast cancer. The faculty review considerations surrounding treatment-related toxicities, particularly interstitial lung disease (ILD), and emphasize the importance of careful patient selection, close monitoring, and prompt management of adverse events in the curative-intent setting. They also explore practical strategies for integrating emerging therapies into clinical practice, including the potential role of response-adapted neoadjuvant approaches that begin with standard HER2-directed therapy before escalating treatment based on clinical response. Dr. Conlin highlights the importance of multidisciplinary coordination and maintaining the opportunity for curative surgery, while Dr. McCann discusses the challenges of managing treatment interruptions and toxicity-related delays. Overall, the conversation underscores the need for individualized treatment planning while balancing therapeutic benefit with patient safety in HER2-positive early breast cancer.