Dr Tripathy on the Treatment of HER2+ Breast Cancer

Debu Tripathy, MD, professor, chairman, Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the current state of HER2-positive breast cancer treatment.

The treatment approach for HER2-positive breast cancer is stratified based on the stage of the disease at diagnosis, Tripathy begins. For patients with clinical stage I disease, characterized by smaller tumor size and no detectable spread to lymph nodes via imaging, a de-escalated therapy approach is often adopted to minimize toxicity, he says. Treatment for these patients typically involves initial surgical intervention followed by a regimen of weekly paclitaxel plus trastuzumab (Herceptin) for 12 weeks, with continued trastuzumab for a full year, Tripathy explains. Patients with hormone receptor (HR)–positive tumors also receive concurrent endocrine therapy, enabling the use of less aggressive treatments and simultaneously maintaining efficacy, according to Tripathy.

For patients presenting with more advanced disease beyond clinical stage I, neoadjuvant therapy is employed to shrink the tumor prior to surgery, he continues. This approach aims to facilitate less invasive surgical options, potentially increasing the likelihood of breast-conserving surgery. Neoadjuvant regimens for advanced HER2-positive breast cancer often include escalated therapies,such as taxanes combined with dual antibody therapy using both trastuzumab and pertuzumab (Perjeta), Tripathy reports.

Some oncologists opt to include platinum-based chemotherapy in the neoadjuvant setting, Tripathy expands. Because the role of platinum agents in this context remains somewhat unclear, platinum-based therapies are sometimes omitted due to associated toxicities, and decisions are guided by the achievement of a pathologic complete response (pCR), he states. Patients who achieve a pCR, indicating complete eradication of cancer in both the primary tumor and lymph nodes, continue with dual-antibody therapy and adjuvant endocrine therapy if they have HR-positive disease, Tripathy notes. Conversely, patients who do not achieve a pCR may be transitioned to alternative therapies, such as ado-trastuzumab emtansine (Kadcyla), to complete the treatment course over a specified duration. These personalized treatment approaches highlight the importance of tailoring treatment strategies based on individual patient response and disease characteristics, he concludes.