Angela M. DeMichele, MD, professor of Medicine and Epidemiology, University of Pennsylvania, discusses the importance of neoadjuvant treatment for patients with HER2-positive breast cancer.

The neoadjuvant setting holds a high level of importance for patients, DeMichele says, because it not only provides an opportunity to improve pathological complete response rates, but it allows oncologists to determine optimal, and personalized, treatment approaches for individual patients.

One of the benefits with the I-SPY2 program is that patients are not required to remain on a treatment long-term if there is no evidence of response. Oncologists can develop better techniques, such as MRI, to determine what additional therapies they can switch their patients to.

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Dr. DeMichele on Importance of Neoadjuvant Care in HER2+ Breast Cancer

Angela M. DeMichele, MD, professor of Medicine and Epidemiology, University of Pennsylvania, discusses results of the HER2-positive breast cancer cohort of the phase II ISPY-2 trial, which investigated the neoadjuvant combinations of ado-trastuzumab emtansine (T-DM1) and pertuzumab (Perjeta) versus paclitaxel (Abraxane) and trastuzumab (Herceptin).

With I-SPY2, researchers are able to investigate multiple active agents simultaneously and can minimize the number of patients enrolled to find effective agents, DeMichele explains. In the HER2-positive breast cancer cohort, following the combination treatment, all patients went on to receive 4 cycles of doxorubicin and cyclophasphamide before surgery. The primary endpoint of the trial was pathological complete response (pCR). 

Results showed that the combination of T-DM1 and pertuzumab was approximately 30% more likely to achieve a pCR in patients compared with paclitaxel and trastuzumab. Additionally, DeMichele adds, patients in the T-DM1 and pertuzumab arm also experienced less toxicity.

View more from the 2016 AACR Annual Meeting

Angela M. DeMichele, MD

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Dr. DeMichele on Importance of Neoadjuvant Care in HER2+ Breast Cancer

Dr. DeMichele on the I-SPY2 Trial for HER2+ Breast Cancer