Dr. Brufsky on Treatment Approaches for Early-Stage HER2+ Breast Cancer

Adam M. Brufsky, MD, PhD, a professor of medicine, associate chief in the Division of Hematology/Oncology, and co-director of Comprehensive Breast Cancer Center at the University of Pittsburgh School of Medicine, discusses the treatment of early-stage, HER2-positive breast cancer.

Generally, patients with early-stage, metastatic HER2-positive breast cancer are treated depending on the size of their tumor, says Brufsky. If the tumor is greater than 2 cm, patients will receive neoadjuvant chemotherapy, usually with trastuzumab (Herceptin) and pertuzumab (Perjeta). If the patient achieves a pathologic complete response, they will then receive trastuzumab or pertuzumab for 1 year; if they do not, they will receive ado-trastuzumab emtansine (T-DM1; Kadcyla).

For patients with tumors of less than 1 cm, they will undergo surgery and then a decision will be made on next steps. If they have tumors that are less than 2 cm and are node negative, they will likely receive adjuvant paclitaxel and trastuzumab for 12 cycles or 12 weeks. Some will give T-DM1 for 1 year, but that decision is a little controversial right now, concludes Brufsky.