Dr. Tolaney on Novel Approaches in Treating HER2-Positive 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, Harvard Medical School, discusses novel approaches in treating patients with HER2-positive breast cancer.

Treatment for patients with HER2-positive disease has dramatically changed over the past decade, with many approvals of new HER2-directed therapies, which have substantially improved outcomes for patients, says Tolaney. In the adjuvant setting, pertuzumab (Perjeta), when added to chemotherapy and trastuzumab (Herceptin), extends progression-free survival. Updated data presented at the 2019 San Antonio Breast Cancer Symposium suggest that the pertuzumab benefit is for both patients with hormone receptor (HR)—positive and HR–negative breast cancer.

There have also been data on ado-trastuzumab emtansine (T-DM1; Kadcyla) in the KATHERINE trial, which demonstrated that patients who were treated with T-DM1 compared with trastuzumab-based therapy experienced a significant improvement in disease-free survival, and patients experienced half of the number of recurrences as those in the trastuzumab arm. Those data have changed the standard of care, Tolaney adds.

In the early HER2-positive setting, the current standard-of-care treatment is to give preoperative therapy to patients with stage II and III disease. For patients with residual disease, they are treated with T-DM1 and if patients have no residual disease, then they will continue treatment with trastuzumab/pertuzumab, concludes Tolaney.