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In part two of this series, the panel discusses the multiple new therapies that have been recently approved for the treatment of early stage breast cancer. With these multiple therapies, the challenge facing many physicians is how to optimally sequence treatment.
William J. Gradishar, MD, believes the goal should be to avoid the use of chemotherapy, since it generally comes with more severe side effects. Additionally, he notes that the development of future therapies will become difficult since the required number of patients for trials will be hard to attain, since so many lines of therapies already exist. As an example, Linda T. Vahdat, MD, notes that since its approval in June she has not had a chance to use the agent pertuzumab, since none of her HER2-positive patients have relapsed.
In addition to newly approved agents, trials are currently underway examining the optimal duration of treatment with hormonal therapy regimens. Gradishar notes that data on the optimal duration of treatment with hormonal therapy has not yet been defined; however, trials are underway examining various durations of treatment, including 5, 10, and 15 years. Joyce A. O'Shaughnessy, MD, notes that if patients are responding well and do not have severe side effects that she will generally continue therapy. However, the duration of treatment should be individualized based on the side effects and response of each patient to therapy.