Neelima Denduluri, MD, associate chair of Breast Medical Oncology and medical oncologist, Virginia Cancer Specialists, of the US Oncology Network, shares treatment approaches in patients with early-stage hormone receptor (HR)—positive, HER2-negative breast cancer.

The most common subtype of breast cancer in the early setting is HR-positive, HER2-negative breast cancer, says Denduluri. To appropriately treat that subtype of breast cancer, patients are always offered surgery and sometimes radiation. Investigators are learning that systemically, this subtype of breast cancer can further be divided into additional molecular subtypes, says Denduluri. Additionally, many patients can be treated safely with surgery and radiation and do not require systemic therapy beyond endocrine therapy, adds Denduluri.

However, patients with other subtypes of breast cancer within HR-positive HER2-negative disease will need more therapeutic modalities, including chemotherapy, says Denduluri. Now, genomic assays can help inform which patient populations can safely receive endocrine therapy alone and in whom treatment must be escalated. Using the genomic assays, a tumor sample is sent to the lab to obtain information regarding the patient’s risk of the recurrence. Patients with a higher risk of recurrence will require more than endocrine therapy by itself. Patients whose tumors have a low biological risk will probably do well with endocrine therapy alone, concludes Denduluri.

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Neelima Denduluri, MD, shares treatment approaches in patients with early-stage hormone receptor-positive, HER2-negative breast cancer.

Dr. Denduluri on Treatment Approaches in Early-Stage HR+/HER2- Breast Cancer

Neelima Denduluri, MD, medical oncologist, Virginia Cancer Specialists, discusses the use of the Oncotype DX assay in early-stage hormone receptor—positive, HER2-negative breast cancer.

Oncotype DX can help identify which patients need chemotherapy in addition to endocrine therapy as well as those who can be spared the toxicities associated with chemotherapy, explains Denduluri. For example, data from the phase III TAILORx trial demonstrated that women with node-negative, HR-positive, HER2-negative disease who have a low Oncotype DX recurrence score can safely avoid chemotherapy. These data can also be applied to men with breast cancer, says Denduluri. Additionally, patients with low-risk, node-positive disease have a good prognosis and may not need chemotherapy.

However, clinical risk should be considered in conjunction with genomic risk, particularly for patients with an intermediate recurrence score, says Denduluri. For example, patients under the age of 50 who may not have gone through menopause need escalated therapy, whether it’s with a second modality of endocrine therapy or chemotherapy, concludes Denduluri.

Neelima Denduluri, MD,  discusses the use of the Oncotype DX assay in early-stage hormone receptor–positive, HER2-negative breast cancer.

Dr. Denduluri on the Use of the Oncotype DX Assay in Early-Stage HR+/HER2- Breast Cancer

Neelima Denduluri, MD, medical oncologist, Virginia Cancer Specialists, discusses the role of neoadjuvant therapy in HER2-positive breast cancer and triple-negative breast cancer.

Historically, once a patient’s tumor has been surgically removed, they go on to receive adjuvant therapy to minimize their risk of recurrence. Over the past five years, research has shown thatneoadjuvant therapy can reduce a patient’s disease burden and can be given in the form of HER2-directed therapy, endocrine therapy, or chemotherapy. Notably, a patient who has a favorable response to neoadjuvant therapy often has a better overall outcome, says Denduluri.

Ultimately, if a patient has high-risk disease, they should be considered for neoadjuvant therapy, advises Denduluri.

Dr. Denduluri on the Role of Neoadjuvant Therapy in HER2+ Breast Cancer

Neelima Denduluri, MD, medical oncologist, Virginia Cancer Specialists, discusses treatment for patients with estrogen receptor (ER)-positive, HER2-negative breast cancer.

There are several therapies available for patients with ER-positive, HER2-negative breast cancer. Although CDK4/6 inhibitors have transformed the way these patients are treated, physicians have had access to potent targeted therapies for decades, including tamoxifen, fulvestrant, aromatase inhibitors, and other anti-estrogen agents. However, these agents used in combination with CDK4/6 inhibitors have resulted in tremendous strides for patients with stage IV breast cancer, says Denduluri. Further, physicians are anticipating the introduction of the PIK3CA inhibitor, alpelisib (BYL719).

The CDK4/6 inhibitors have transformed how physicians treat ER-positive, HER2-negative breast cancer in the metastatic setting, adds Denduluri. They’ve delayed the time to chemotherapy by more than double that of historical standards. All 3 inhibitors—–ribociclib (Kisqali), palbociclib (Ibrance), and abemaciclib (Verzenio) are oral drugs that enhance the efficacy of current anti-estrogen therapy. Regardless of the extent of disease, age of the patient, or pre/postmenopausal status, CDK4/6 inhibitors improve outcomes for patients when used in combination with anti-estrogen therapy, concludes Denduluri.

Neelima Denduluri, MD

Articles

Dr. Denduluri on Treatment Approaches in Early-Stage HR+/HER2- Breast Cancer

Dr. Denduluri on the Use of the Oncotype DX Assay in Early-Stage HR+/HER2- Breast Cancer

Dr. Denduluri on the Role of Neoadjuvant Therapy in HER2+ Breast Cancer

Dr. Denduluri on Treatment for ER+/HER2- Breast Cancer