Dr. Traina on Treatment Considerations for HER2+ Breast Cancer

Tiffany A. Traina, MD, medical oncologist, Memorial Sloan Kettering Cancer Center, on considerations for the treatment of patients with HER2-positive breast cancer.

With the FDA approval of neratinib (Nerlynx) in July of 2017, clinicians began to consider its role in the treatment paradigm of HER2-positive breast cancer. With the success of pertuzumab (Perjeta), and the established role of trastuzumab (Herceptin), some clinicians have found it difficult to decide where to place neratinib in the sequence of treatment for these patients.

Traina says that she favors using pertuzumab in patients with tumors larger that 2 cm in the setting of node negative or positive disease. She also incorporates neoadjuvant therapy with anthracycline taxane-based trastuzumab and pertuzumab, and then following surgery, administering trastuzumab and pertuzumab for a full year. For tumors that are smaller than 2 cm, Traina supports the idea of de-escalation. Neratinib, she says, is difficult to place, but it could be an option for patients that are extremely high risk after prior treatment.