Gretchen G. Kimmick, MD, MS, professor of medicine, Duke University School of Medicine, ​member, Duke Cancer Institute, discusses selecting adjuvant therapy for patients with HER2-positive breast cancer. 

Patients with low-risk, early-stage, HER2-positive breast cancer often have tumors that are less than 2 cm and do not involve lymph nodes or micrometastases, Kimmick explains. In these patients, particularly those with tumors that are less than 1 cm, several adjuvant therapeutic options are available. These regimens have different treatment schedules and toxicities, so it is important to tailor treatment selection based on the individual patient, according to Kimmick.

For example, a patient who is a musician may not want to risk developing neurotoxicity with chemotherapy, so ado-trastuzumab emtansine (T-DM1; Kadcyla) may be the optimal adjuvant option for them, Kimmick explains. Additionally, a patient whose schedule does not allow them to come into the clinic weekly for treatment may be best suited with docetaxel/cyclophosphamide/trastuzumab (Herceptin) or T-DM1 compared with the APT regimen comprised of weekly paclitaxel followed by 1 year of trastuzumab. Ultimately, however, the APT regimen remains the most utilized adjuvant treatment choice for this patient population, Kimmick concludes. 

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Gretchen G. Kimmick, MD, MS, discusses selecting adjuvant therapy for patients with HER2-positive breast cancer.  



Dr. Kimmick on Selecting Adjuvant Therapy for Patients With HER2+ Breast Cancer 

Gretchen G. Kimmick, MD, MS, professor of medicine, Duke University School of Medicine, ​member, Duke Cancer Institute, discusses the quickly evolving treatment paradigm for patients with HER2-positive breast cancer. 

Efforts are being made to provide the most beneficial options for those with either early-stage or metastatic disease, according to Kimmick. Because new agents are being developed so rapidly, treatment decisions in the adjuvant setting have become more complex, Kimmick says.

Questions remain regarding when patients should receive either neoadjuvant therapy or adjuvant therapy after neoadjuvant therapy when residual disease is detected, Kimmick adds. Most patients with HER2-positive disease will receive neoadjuvant therapy due to symptoms associated with fast-growing tumors, so surgeons should be prepared for this treatment, Kimmick explains. In the adjuvant setting, ado-trastuzumab emtansine (T-DM1; Kadcyla) is demonstrating better efficacy than trastuzumab (Herceptin) alone. Other novel agents are also under investigation, Kimmick concludes.

Gretchen G. Kimmick, MD, MS, discusses the quickly evolving treatment paradigm for patients with HER2-positive breast cancer. 

Dr. Kimmick on the Evolving HER2+ Breast Cancer Treatment Paradigm

Gretchen G. Kimmick, MD, MS, professor of medicine, Duke University School of Medicine, ​member, Duke Cancer Institute, discusses the results of the phase 2 ATEMPT (NCT01853748) trial in early-stage HER2-positive breast cancer.

The ATEMPT trial randomized patients with stage I HER2-positive breast cancer to ado-trastuzumab emtansine (T-DM1; Kadcyla) vs adjuvant paclitaxel plus trastuzumab (Herceptin; TH). Patients’ tumors were less than 2 centimeters and did not involve lymph nodes or only had micrometastasesin the lymph nodes, Kimmick explains.

The disease-free survival results of the trial were in favor of T-DM1, which offered another option for patients with early-stage breast cancer, Kimmick continues. However, clinically relevant toxicities were not decreased with T-DM1 vs TH; 17% of patients receiving T-DM1 discontinued before completion of treatment compared with 6% of patients with TH. Although T-DM1 could be considered as a therapeutic option for patients with early-stage HER2-positive breast cancer, data are needed to determine the clinical implications of early treatment discontinuation with the agent, Kimmick concludes.

Gretchen G. Kimmick, MD, MS, discusses the results of the phase 2 ATEMPT trial in early-stage HER2-positive breast cancer 


Gretchen G. Kimmick, MD, MS

Articles

Dr. Kimmick on Selecting Adjuvant Therapy for Patients With HER2+ Breast Cancer

Dr. Kimmick on the Evolving HER2+ Breast Cancer Treatment Paradigm

Dr. Kimmick on the Results of the ATEMPT Trial in Early-Stage HER2+ Breast Cancer