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Frankie Ann Holmes, MD, a physician at Texas Oncology, discusses neoadjuvant endocrine therapy for patients with breast cancer.

Dr. Holmes on Neoadjuvant Endocrine Therapy in Breast Cancer

Frankie Ann Holmes, MD, a physician at Texas Oncology, discusses neoadjuvant duel HER2-directed therapy in breast cancer.

Neoadjuvant directed therapy is seeing extremely high total pathological complete response rates. For patients whose tumors are greater than 2 centimeters or are node-positive, dual anti—HER2-directed therapy with trastuzumab and pertuzumab (Perjeta) either with a taxane carboplatin backbone or, with the anthracycline cytoxin then taxane backbone, have shown to be very effective and are the optimal choices of therapy for those patients, said Holmes.

Patients that are ER-negative that have the HER-enriched phenotype have much more aggressive disease and may need the duel HER2-targeted therapy, while patients with more Luminal disease may not, said Holmes. Questions still remain regarding treatment for patients that do not meet the criteria for duel HER2-directed therapy.

Biomarkers will need to be discovered to determine which patients need maximum therapy, which comes with additional costs and toxicities, and which ones do not, she said.

Dr. Frankie Ann Holmes on Duel Anti-HER2-Directed Therapy in Breast Cancer

Frankie Ann Holmes, MD, a physician at Texas Oncology, discusses the MA.17R trial, which evaluated how long treatment with aromatase inhibitors should be given to patients with early-stage breast cancer.

In the trial, patients were randomized to receive continued use of letrozole or placebo after receiving 5 years of letrozole.

At a median follow-up of 10 years, an overview of the study showed that there was a continued recurrence out to 20 years. This is still relatively early in the natural history of the disease, and more relapses could still occur, says Holmes.

A risk analysis needs to be conducted to determine which patients are at the greatest risk of late recurrence. The Breast Cancer Index (BCI) is one tool that is used in practice to predict risk. This and other tools will help oncologists individualize and personal treatment for each patient.

Frankie Ann Holmes, MD

Articles

Dr. Holmes on Neoadjuvant Endocrine Therapy in Breast Cancer

Dr. Frankie Ann Holmes on Duel Anti-HER2-Directed Therapy in Breast Cancer

Dr. Holmes Discusses Late Recurrence and the MA.17R Trial in Breast Cancer