Martine Extermann, MD, PhD, professor of oncology and medicine, University of South Florida, program leader, Senior Adult Oncology Program, Moffitt Cancer Center, discusses the significance of novel treatment options in HER2-positive breast cancer. 

The third-line treatment options fam-trastuzumab deruxtecan (Enhertu) and tucatinib (Tukysa) were welcome additions to the HER2-positive breast cancer armamentarium, Extermann says. Moreover, the FDA-approved agents have demonstrated significant activity in this patient population, including those with brain metastases in the case of tucatinib. 

Moreover, it was intriguing to see the results of the phase 3 OlympiA trial (NCT02032823), in which adjuvant olaparib (Lynparza) prolonged survival vs placebo in patients with high-risk, HER2-positive early breast cancer and germline 

 pathogenic or likely pathogenic variants who completed local treatment and neoadjuvant/adjuvant chemotherapy. 

Moreover, it remains important to develop novel therapies directed toward older patients with HER2-positive breast cancer because 25% of breast cancer occurs in patients over the age of 75, Extermann continues. Developments have been made with a potential low-toxicity regimen, refined radiation approaches, and optimized treatment selection, Extermann concludes.

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Martine Extermann, MD, PhD, discusses the significance of novel treatment options in HER2-positive breast cancer. 


Dr. Extermann on the Significance of Novel Treatment Options in HER2+ Breast Cancer 

Martine Extermann, MD, PhD, professor of oncology and medicine, University of South Florida, and program leader, Senior Adult Oncology Program, Moffitt Cancer Center, shares advice for selecting among the CDK4/6 available for the treatment of patients with hormone receptor (HR)–positive breast cancer.

Currently, 3 CDK4/6 inhibitors are FDA approved for use in this patient population: palbociclib (Ibrance), ribociclib (Kisqali), and abemaciclib (Verzenio). These agents have had a significant impact on the frontline treatment of patients with metastatic disease, and data from various studies suggest that they have a durable effect, Extermann adds.

Although there has been some debate with regard to survival benefit differences among these 3 agents, the consensus is that they are essentially equivalent in effectiveness, according to Extermann. However, the available CDK4/6 inhibitors do have different adverse effect profiles, and therefore, toxicity considerations should be used to inform treatment decisions for each patient, Extermann concludes.

Martine Extermann, MD, PhD, shares advice for selecting among the CDK4/6 available for the treatment of patients with hormone receptor–positive breast cancer.

Dr. Extermann on Selecting Among Available CDK4/6 Inhibitors in HR+ Breast Cancer 

Martine Extermann, MD, PhD, professor of oncology and medicine, University of South Florida, program leader, Senior Adult Oncology Program, Moffitt Cancer Center, discusses the utility of single-agent trastuzumab (Herceptin) in HER2-positive breast cancer.

Findings from the phase 3 RESPECT trial (NCT01104935) failed to demonstrate noninferiority with trastuzumab monotherapy compared with trastuzumab plus chemotherapy in older patients with early-stage HER2-positive breast cancer, Extermann says. At 3 years, the estimated relapse-free survival rate was 92.4% with trastuzumab monotherapy compared with 95.3% with trastuzumab plus chemotherapy (HR, 1.33; 95% CI, 0.63-2.79; 

 = .53). However, patients who received trastuzumab alone had improved quality of life and less adverse effects compared with those who received trastuzumab plus chemotherapy, Extermann explains. 

As both regimens yielded high response rates, older patients who are reluctant to receive chemotherapy could be effectively treated with trastuzumab monotherapy without significantly compromising survival, Extermann concludes. 

Martine Extermann, MD, PhD, discusses the utility of single-agent trastuzumab in HER2-positive breast cancer.  



Martine Extermann, MD, PhD

Articles

Dr. Extermann on the Significance of Novel Treatment Options in HER2+ Breast Cancer

Dr. Extermann on Selecting Among Available CDK4/6 Inhibitors in HR+ Breast Cancer

Dr. Extermann on the Utility of Trastuzumab Monotherapy in HER2+ Breast Cancer