Choosing Therapies for Early-Stage HER2+ Breast Cancer

William J. Gradishar, MD, discusses the choice of adjuvant or neoadjuvant regimens for patients with HER2-positive breast cancer.

William J. Gradishar, MD, professor of medicine (hematology and oncology), Betsy Bramsen Professor of Breast Oncology, and chief of hematology and oncology in the Department of Medicine at the Feinberg School of Medicine at Northwestern University, discusses the choice of adjuvant or neoadjuvant regimens for patients with HER2-positive breast cancer.

A preferred preoperative or adjuvant therapy for this setting is docetaxel and carboplatin chemotherapy plus trastuzumab (Herceptin) plus pertuzumab (Perjeta), according to Gradishar. In some patients in whom pertuzumab may be avoided, paclitaxel plus trastuzumab or docetaxel, carboplatin, and trastuzamab could be used. In the postoperative setting, a regimen containing trastuzumab and pertuzumab regimen would be also used, especially if the tumor was larger or if there were lymph node metastases.

Those with a tumor of up to 3 cm may receive the adjuvant regimen of paclitaxel plus trastuzumab based on the phase 2 Adjuvant Paclitaxel and Trastuzumab (APT) trial (NCT00542451) principally investigated by Sara E. Tolaney, MD, MPH.

The long-term results of the APT trial show a 93% 7-year disease-free survival rate and only a 1.0% rate of distant recurrence. Because of this, Gradishar says that patients with smaller tumors can avoid pertuzumab and additional chemotherapy, reducing the toxicity they will experience while minimizing risk of recurrence.


0:08 | [For early-stage breast cancer], the usual treatment is to, if they're getting preoperative therapy, we use chemotherapy plus trastuzumab and pertuzumab for most patients. There may be particular situations where pertuzumab is not utilized, and it may be a taxane and trastuzumab. Similarly, postoperatively if we saw a patient having had surgery, we would still think about using for most patients an [trastuzumab plus pertuzumab] regimen, particularly if they had a bigger tumor or positive nodes. If they had a smaller tumor, then we use the Tolaney regimen, which would have been trastuzumab and a taxane. The long-term results of the APT trial are pretty compelling that there are very few recurrences. And in that particular setting, then I think it's acceptable to avoid additional chemotherapy as well as pertuzumab.