Using Systemic Therapy to Treat HER2+ Breast Cancer

Lisa A. Carey, MD, FASCO: Thank you. This was a rich, informative discussion. Any last thoughts from any of you? Reshma, Lee, V.K.?

Reshma Mahtani, DO: I would end by saying that I think many of us are appreciative of the fact that HER2-positive disease is a double-edged sword. We have an aggressive disease, but we have many targeted therapies, and I think it’s interesting to see how younger physicians and fellows in training have a different view of HER2-positive disease. They almost don’t appreciate that aggressiveness of the disease because they took care of patients prior to the era of us having all these available therapies. I think that’s a testament to the progress that we’ve made. The fact that we’re having these conversations is a good problem to have because it means there’s progress for our patients.

Lisa A. Carey, MD, FASCO: It was the worst prognosis subset.

Vijayakrishna Gadi, MD, PhD: Yes.

Lisa A. Carey, MD, FASCO: Lee? V.K.?

Lee S. Schwartzberg, MD, FACP: I tell my patients now, when they present with HER2 disease, that this used to be the worst, but now, with the right drugs, it’s arguably the best prognosis group in breast cancer. I remember, I’m old enough, when I participated in the original, pivotal trial that was AC [doxorubicin and cyclophosphamide]with trastuzumab, and they added the taxane on because it wasn’t accruing. No one could believe that an antibody could do something in this disease. We got this trial drug, and the rest is history. It’s wasn’t that long ago, it was a couple of decades ago, but look how well we’ve done since then.

Lisa A. Carey, MD, FASCO: I’m so sorry I missed that era. V.K.?

Vijayakrishna Gadi, MD, PhD: I’ll close by saying that with the richness of the agents we have, I’m heartened by the discussion of patient-centered optimization rather than just adding medications. We, in very thoughtful ways, can negotiate with our patients to say, “Hey, listen, this is the right amount of therapy. You don’t need anthracycline in the pre-operative setting. You can stay with chemotherapy and this injectable, trastuzumab, for a period of time, and you’ll be fine.” For others, it might be a very different conversation. But I’m grateful that as a group of investigators, we’ve performed the studies that help us guide this type of optimization for our patients. I’m, again, still very optimistic about where we’re headed with all of this.

Lisa A. Carey, MD, FASCO: Thank you. This has been fantastic. You have such thoughtful commentary and great thoughts about practical and emerging arenas as well. Thanks to the viewing audience. We hope you found this OncLive® Peer Exchange discussion useful and informative—I know I did. Thank you to everyone.

Transcript Edited for Clarity