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Expert Discusses Developments in HER2+ Breast Cancer

Caroline Seymour
Published: Friday, Oct 12, 2018

A. Jo Chien, MD

A. Jo Chien, MD

Novel agents—including pertuzumab (Perjeta), neratinib (Nerlynx), and the investigational agent tucatinib—are rapidly expanding the armamentarium in HER2-positive breast cancer. The key now, explained A. Jo Chien, MD, is optimizing patient selection for these treatments.

State of the Science Summit™ on Breast Cancer, Chien, associate clinical professor, Department of Medicine, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discussed emerging agents and other developments in HER2-positive breast cancer.

OncLive: What is being discussed in early-stage and metastatic HER2+ breast cancer?

Chien: In the field of HER2-positive breast cancer right now, there are challenges in identifying patients who remain high risk despite trastuzumab.

On the flip side, there are patients who we are probably overtreating. Historically, our studies were done in patients with relatively high-risk disease—those with node-positive disease and larger tumors. Now, we are identifying patients with smaller tumors and node-negative disease and finding that maybe they don't need as intensive treatment.

Please expand on the emerging agents.

In the early-stage setting, that includes pertuzumab, which is an antibody against HER2 that blocks dimerization. We know that it improves pathologic complete response (pCR) rates in the neoadjuvant setting. We have also seen adjuvant data that have shown small benefit. The question is, “Who needs that additional benefit?” There are additional side effects that come along with it, such as diarrhea and rash.
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