Treatment Continuum in HER2-Positive Early Breast Cancer

Dr. Jason Mouabbi outlines the current treatment continuum for patients with high-risk HER2-positive early breast cancer, beginning with neoadjuvant systemic therapy and continuing through surgery and post-neoadjuvant management. He discusses clinical and pathologic factors used to characterize higher-risk disease and describes the historical use of an anthracycline-free TCHP regimen in the neoadjuvant setting. The conversation highlights the importance of assessing pathologic response at surgery, particularly whether patients achieve a pathologic complete response or have residual invasive disease, as this finding can influence subsequent treatment decisions and recurrence risk. Dr. Mouabbi reviews continuation of HER2-directed therapy for patients achieving pathologic complete response and the established role of T-DM1 following residual disease based on KATHERINE, while also introducing emerging data with T-DXd from DESTINY-Breast05. He discusses additional considerations such as CNS recurrence and neratinib, particularly in patients with higher nodal burden. Dr. Rao also emphasizes the importance of incorporating endocrine therapy for patients with hormone receptor-positive disease.