Dr. Tolaney on Navigating Adjuvant Therapy in Early-Stage HER2+ Breast Cancer

Sara M. Tolaney, MD, MPH, associate director, Susan F. Smith’s Center for Women’s Cancers, director, Clinical Trials, Breast Oncology, senior physician, Dana-Farber Cancer Institute, and assistant professor of medicine at Harvard Medical School, discusses considerations for adjuvant therapy in patients with early-stage HER2-positive breast cancer.

The data from the phase III APHINITY trial demonstrated a progression-free survival (PFS) benefit with the addition of pertuzumab (Perjeta) to trastuzumab (Herceptin) and chemotherapy in patients with early-stage HER2-positive breast cancer. Initial follow-up showed a modest benefit in PFS that was restricted to patients with node-positive and hormone receptor (HR)—negative disease. Updated data show a benefit in those with HR–positive disease as well.

As such, pertuzumab should be considered as adjuvant therapy in all patients who receive neoadjuvant therapy, as these are generally patients with tumors ≥2 centimeters or who have lymph node involvement—the same population that derived benefit from pertuzumab in the APHINITY trial. Patients who have residual disease following adjuvant therapy with ado-trastuzumab emtansine (T-DM1; Kadcyla) could also continue on pertuzumab/trastuzumab, concludes Tolaney.