Ruta D. Rao, MD, associate professor, Department of Internal Medicine, Division of Hematology, Oncology, and Cell Therapy, Rush Medical College, director, Coleman Foundation Comprehensive Breast Cancer Clinic, medical director, Rush University Cancer Center, discusses how the updated National Comprehensive Cancer Network (NCCN) guidelines have influenced treatment selection for patients with HER2-positive breast cancer.

The NCCN guidelines now recommend fam-trastuzumab deruxtecan-nxki (Enhertu) as a second-line treatment option for patients with metastatic HER2-positive breast cancer, Rao explains. Although ado-trastuzumab emtansine (T-DM1; Kadcyla) is also a recommended second-line agent, trastuzumab deruxtecan has been listed as a preferred regimen. These guidelines support selecting trastuzumab deruxtecan over T-DM1 in this patient population, Rao says.

Additionally, the guidelines list several regimens as recommended third-line treatment options, including the combination of trastuzumab (Herceptin), capecitabine (Xeloda), and tucatinib (Tukysa). Other HER2-directed agents like neratinib (Nerlynx), margetuximab-cmkb (Margenza), and trastuzumab in combination with chemotherapy are also recommended for patients with metastatic HER2-positive disease in need of third-line treatment, Rao concludes.

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Ruta D. Rao, MD, discusses how the updated National Comprehensive Cancer Network guidelines have influenced treatment selection for patients with HER2-positive breast cancer.  



Dr. Rao on Incorporating Updated NCCN Guidelines Into Treatment Selection for HER2+ Breast Cancer 

Ruta D. Rao, MD, an associate professor at Rush University Medical Center, discusses therapy de-escalation for patients with early-stage hormone receptor (HR)-positive, HER2-negative breast cancer.

There are several genomic platforms that can be used to determine which patients with early-stage HR-positive, HER2-negative breast cancer would benefit from adjuvant chemotherapy, explains Rao. Previously, adjuvant chemotherapy was given to patients who had certain characteristics based on tumor size or lymph node status. However, recent data show that the tumor biology may more accurately predict an individual’s risk of recurrence. By identifying the tumors that have a higher risk of recurrence, overtreatment can be avoided in the majority of patients with early-stage breast cancer, says Rao. Additionally, more focus can be put on appropriately treating the patients at higher risk.

In terms of available assays, the TAILORx study demonstrated that Oncotype DX is helpful in patients with estrogen- and/or progesterone receptor-positive, HER2-negative, node-negative breast cancer. Whereas, in the MINDACT trial, MammaPrint was used in patients with lymph node-negative as well as lymph node-positive breast cancer.

Dr. Rao on Treatment De-Escalation in HR+/HER2- Breast Cancer

Ruta D. Rao, MD, associate professor, Rush University Medical Center, discusses the results of the SOFT trial, presented at the 2017 San Antonio Breast Cancers Symposium.

Updated results from the SOFT trial presented by Gini F. Fleming, MD, showed that the addition of ovarian suppression benefited patients with premenopausal breast cancer. The trial enrolled approximately 3000 patients who were randomized into 1 of 3 arms. Patients were randomized to either tamoxifen, tamoxifen plus ovarian suppression, or exemestane plus ovarian suppression.

The analysis compared tamoxifen with tamoxifen plus ovarian suppression and found that there was a significantly improved disease-free survival for these patients. This was especially true in the patients who had received prior chemotherapy, notes Rao.

Ruta D. Rao, MD

Articles

Dr. Rao on Incorporating Updated NCCN Guidelines Into Treatment Selection for HER2+ Breast Cancer

Dr. Rao on Treatment De-Escalation in HR+/HER2- Breast Cancer

Dr. Rao on the SOFT Trial in Patients With Premenopausal Breast Cancer