Julie Gralow, MD

Julie Gralow, MD, the clinical director of Breast Medical Oncology at the Seattle Cancer Care Alliance, professor of Medical Oncology at the University of Washington School of Medicine, and professor of the Clinical Research Division at the Fred Hutchinson Cancer Research Center, discusses the primary analysis of trastuzumab emtansine (T-DM1; Kadcyla) plus pertuzumab (Perjeta) versus trastuzumab (Herceptin), pertuzumab, and taxane, after anthracyclines as adjuvant therapy in patients with high-risk HER2-positive early breast cancer in the of the KAITLIN study (NCT01966471). 

At the 2020 American Society of Clinical Oncology Virtual Meeting, the trial showed that there was no difference between the 2 regimens. The T-DM1 and pertuzumab group did not do better than those receiving classic chemotherapy as well, according to Gralow. During the chemotherapy phase, the adverse events (AEs) and quality of life was better with T-DMI and pertuzumab. After patients were done with chemotherapy and completed a year of treatment, the T-DM1 arm had more patients dropping out than the arm receiving trastuzumab, pertuzumab, and taxane. 

Patients who didn’t complete therapy could cross over to trastuzumab monotherapy or trastuzumab and pertuzumab. Gralow thinks that this allowance of crossing over is interesting because when giving chemotherapy, T-DM1 and pertuzumab is better; when patients are only on trastuzumab and pertuzumab portion for the year-long therapy, T-DM1 had more AEs. Gralow says it’s a reasonable regimen, although it didn’t meet the primary end point.

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Julie Gralow, MD, discusses the primary analysis of trastuzumab emtansine plus pertuzumab versus trastuzumab, pertuzumab, and taxane, after anthracyclines as adjuvant therapy in patients with high-risk HER2-positive early breast cancer in the of the KAITLIN study.

Phase 3 Trial Investigates T-DM1 and Pertuzumab in HER2+ Breast Cancer

Julie Gralow, MD, the clinical director of Breast Medical Oncology at the Seattle Cancer Care Alliance, professor of Medical Oncology at the University of Washington School of Medicine, and professor of the Clinical Research Division at the Fred Hutchinson Cancer Research Center, discusses the use of patient-reported outcomes in the SWOG S1105 trial and different factors for patients with early-stage breast cancer on an aromatase inhibitor to see if they could predict who may be more likely to stop taking treatment early.

Gralow says she and the other investigators found that younger patients tended to be less adherent after 3 years and were not on the drug more often than older patients on the study. They also found that patients who had endocrine symptoms or pain, such as joint aches, before starting on therapy were less likely to continue therapy over all 3 years of the trial. Surveys about thoughts and beliefs on medication predicted which patients would discontinue as well.

The investigators found a group who are more adherent who may not need more help with adhering to their regimen, and physicians then can focus on the higher risk group to design interventions to help these patients stay on therapy, according to Gralow. In respect to using text messages to help patients, which was the initial study objective of the study, the investigators have come up with new ideas like making the messages more personalized to what patients reported at baseline or what patients are communicating in the moment. The investigators may try to give tips for how to manage issues, such as using acupuncture to combat joint aches that come with aromatase inhibitors. They also want to try having 2-way communication, so the patients can interact by sending back information and the physician can then tailor the help they are giving the patient.

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Julie Gralow, MD, discusses the use of patient-reported outcomes in the SWOG S1105 trial and different factors for patients with early-stage breast cancer on an aromatase inhibitor to see if they could predict who may be more likely to stop taking treatment early.

Investigating How to Help Patients With Breast Cancer Stay on Therapy

Julie Gralow, MD, Professor, Medical Oncology Division, University of Washington School of Medicine, talks about the importance of women knowing which genetic tests they&rsquo;ve previously had done for breast cancer. Of patients that have had  standard genetic testing and then been referred back for multi-gene testing, 13% of them found a different mutation than they had initially aware of.&nbsp;

Gralow also touches on how genetic testing is increasingly helpful for catching breast cancer in women with a familial high risk of developing the disease.

Julie Gralow, MD, Professor, Medical Oncology Division, University of Washington School of Medicine, talks about the importance of women knowing which genetic tests they�ve previously had done for breast cancer.

Julie Gralow, MD | Authors

Articles

Phase 3 Trial Investigates T-DM1 and Pertuzumab in HER2+ Breast Cancer

Investigating How to Help Patients With Breast Cancer Stay on Therapy

Dr. Julie Gralow on the Importance of Genetic Testing for Breast Cancer