Dr Nanda on Neoadjuvant Treatment in HER2+ Breast Cancer

Rita Nanda, MD, associate professor, medicine, director, Breast Oncology Program, University of Chicago, UChicago Medicine, discusses the future of neoadjuvant treatment for patients with HER2-positive breast cancer, highlighting the importance of targeted therapies.

Nanda discusses both previous and emerging data concerning the use of neoadjuvant therapy in HER2-positive breast cancer and triple-negative breast cancer (TNBC). Neoadjuvant therapy has now become the gold standard for treating patients with stage II and III HER2-positive breast cancer and TNBC, she says. This is primarily because each patient's response to this treatment regimen provides crucial insights into subsequent adjuvant strategies, Nanda states, emphasizing the significance of neoadjuvant therapy data particularly in early-stage HER2-positive breast cancer and TNBC cases.

Moving forward, decisions regarding adjuvant therapy are greatly influenced by the patient's response to neoadjuvant therapy, she expands. Patients exhibiting a favorable response typically continue with HER2-directed therapy involving trastuzumab (Herceptin) and pertuzumab (Perjeta) for HER2-positive breast cancer, or adjuvant pembrolizumab (Keytruda) for TNBC, Nanda relays. However, ongoing trials are exploring alternative treatment approaches for patients who do not achieve a pathological complete response (CR) to neoadjuvant therapy, aiming to refine risk-reduction strategies, she notes.

Furthermore, there is growing interest in optimizing therapy for patients showing exceptional neoadjuvant therapy responses, Nanda continues. This includes potentially reducing the intensity of adjuvant pembrolizumab or tailoring therapy specifically for HER2-positive patients based on their response to taxane-based regimens, possibly reducing or eliminating anthracycline-based treatments, she says. Exciting developments in trials aim to enhance the management of high-risk, early-stage, HER2-positive breast cancer and TNBC cases, Nanda adds. In advanced HER2-positive disease, the introduction of fam-trastuzumab deruxtecan-nxki (Enhertu) has produced notable outcomes, according to Nanda. Consequently, ongoing research is investigating the possibility of integrating this agent into neoadjuvant or adjuvant protocols for patients not achieving a CR to standard therapy, Nanda reports.

As new therapies emerge, they may displace current treatment practices, Nanda says. The future direction of treatment modalities remains dynamic, and anticipation mounts as the breast cancer field awaits further advancements, Nanda concludes.