Debu Tripathy, MD

Debu Tripathy, MD, professor, and chairman, Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses the role margetuximab (Margenza) will have in the field of HER2-positive metastatic breast cancer now that it is approved by the FDA.

Tripathy says that the design of the agent is very interesting as it was created to augment and better interact with the immune system. This is a concept that has been thought of for a long time because the immune system plays an important role in how patients with HER2-positive breast cancer respond to therapy.

In preclinical models, margetuximab stood out from other IgG antibodies because it is engineered for the Fc portion of the antibody. Clinically, margetuximab was tested in humans in the phase in the phase 3 SOPHIA clinical trial (NCT02492711). The study showed did show that margetuximab is making a difference in patients with HER2-positive metastatic breast cancer, Tripathy states. But the level of efficacy observed with the agent in SOPHIA warrant further follow-up.

Overall, Tripathy believes that margetuximab will serve a good purpose for patients withHER2-positive metastatic breast cancer in later-line settings.

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Debu Tripathy, MD, discusses the role that margetuximab will have in the field of HER2-positive metastatic breast cancer now that it is approved by the FDA.

Margetuximab May Be Beneficial for Later-Line HER2-Positive Breast Cancer

Debu Tripathy, MD, professor of medicine and chair of the Department of Breast Medical Oncology at The University of Texas MD Anderson Cancer Center, discusses escalation and de-escalation of treatment in patients with HER2-positive breast cancer with HER2-targeted agents and chemotherapy.

Tripathy says the goal for these patients is to identify who may not need the same amount of treatment as other patients and de-escalating their therapy. By figuring out which patients are at low risk, they could be given a lighter treatment. The opposite is true as well; patients who at high risk should be identified and should have escalated or more intensive therapy.

Trials have shown that patients with low-risk HER2-positive disease such as those with node negativity and a tumor less than 2 or 3 cm in size, can be treated with paclitaxel and trastuzumab (Herceptin). This is a singular chemotherapy drug, which is given to the patient for about 3 months, in combination with a HER2-targeted agent which is given for a year. Tripathy says this regimen has fewer adverse events than what was used previously.

For patients with larger tumor or node positivity, using 2 chemotherapies and 2 antibodies—docetaxel, carboplatin, trastuzumab, and pertuzumab (Perjeta)—will shrink the patient’s cancer before surgery. After treatment, about half of the patients won’t have any invasive disease left at the time of surgery, according to Tripathy. Although there is still a low risk of recurrence, these patients have shown good outcomes after this type of treatment. Usually, patients will continue on a HER2 antibody therapy after surgery.

Debu Tripathy, MD, discusses escalation and de-escalation of treatment in patients with HER2-positive breast cancer with HER2-targeted agents and chemotherapy.

Escalation and De-escalation of Therapy Beneficial in HER2+ Breast Cancer

Debu Tripathy, MD, of the Department of Breast Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, was an investigator in the

. The purpose of the study was to examine how endocrine therapy, in combination with a cyclin-dependent kinase (CDK) inhibitor, affects progression-free survival and overall survival in premenopausal patients with HR-positive, HER2-negative advanced breast cancer.

In the trial, 672 premenopausal female patients under 59 years of age, who had never received endocrine therapy prior, were randomized 1:1 to either ribociclib (Kisqali) or placebo, both with endocrine therapy.

Following treatment with the endocrine therapy and CDK4/6 inhibitor combination, patients who progressed then went on to receive other treatment. These therapies included chemotherapy alone, hormone therapy alone, chemotherapy plus hormone or other therapysuch as biologics including everolimus, or hormone therapy plus other treatment. For these patients, progression-free survival 2, or the time from randomization to progression on second-line therapy or death, was measured.

Debu Tripathy, MD, of the Department of Breast Medical Oncology, Division of Cancer Medicine, MD Anderson Cancer Center, was an investigator in the phase III MONALEESA-7 trial. The purpose of the study was to examine how endocrine therapy, in combination with a cyclin-dependent kinase inhibitor, affects progression-free survival and overall survival in premenopausal patients with HR-positive, HER2-negative advanced breast cancer.

Explaining PFS2 in the MONALEESA-7 Trial for HR+/HER2- Breast Cancer

Debu Tripathy, MD, professor and chair, Department of Breast Medical Oncology at The University of Texas MD Anderson Cancer Center, discusses the use of CDK4/6 inhibitors for the treatment of HER2-negative breast cancer, based on results from the phase III MONALEESA-7 trial.

Tripathy says physicians are more likely to use CDK4/6 inhibitors now, especially in patients with visceral disease who may be symptomatic. Previously, the concern was that endocrine therapy was not enough and chemotherapy was necessary. Now, data is showing higher response rates.

Debu Tripathy, MD, discusses the use of CDK4/6 inhibitors for the treatment of HER2-negative breast cancer based on the results from the phase III MONALEESA-7 trial.

Debu Tripathy, MD | Authors

Articles

Margetuximab May Be Beneficial for Later-Line HER2-Positive Breast Cancer

Escalation and De-escalation of Therapy Beneficial in HER2+ Breast Cancer

Explaining PFS2 in the MONALEESA-7 Trial for HR+/HER2- Breast Cancer

Examining the Use of CDK4/6 Inhibitors in HER2-Negative Breast Cancer