Dr. Pegram on Challenges in Neoadjuvant Treatment for HER2-Positive Breast Cancer

Mark D. Pegram, MD, associate director, clinical research, director, Breast Cancer Program, Stanford Cancer Institute, goes over some of the challenges surrounding neoadjuvant treatment for HER2-positive breast cancer patients.

There is debate about who should receive neoadjuvant treatment. Pegram says he believes that not everyone who has early-stage disease should receive neoadjuvant pertuzumab. Previous data have shown that a combination of 12 weekly doses of paclitaxel plus trastuzumab for a year demonstrated a 3-year projected disease-free survival rate of 98.7% in patients with stage I breast cancer. Pertuzumab couldn’t top this result, Pegram says.

For stage I disease, the combination of paclitaxel plus trastuzumab is arguable the most attractive treatment option in the adjuvant setting. If utilized, many patients would not need neoadjuvant therapy. ​

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