Dr. Chien on De-Escalation Strategies for Patients With HER2-Positive Breast Cancer

A. Jo Chien, MD, associate clinical professor, Department of Medicine, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses de-escalation strategies for patients with HER2-positive breast cancer.

The first approach is looking at de-escalating chemotherapy, says Chien. Physicians used to give aggressive regimens containing anthracyclines. Though the BCIRG 006 study was not powered to look at this, physicians saw very similar long-term outcomes out to 10 years between non-anthracycline and anthracycline-based chemotherapies. In the APT study in patients with stage I node-negative tumors, physicians saw long-term outcomes with disease-free survival rates of 94% at 7 years of follow-up.

Another approach is looking at the duration of trastuzumab (Herceptin). Physicians know that patients do not benefit from more than 1 year of trastuzumab, but because 1 year was chosen arbitrarily, it may be worth investigating lower durations, explains Chien. Moreover, giving just hormone therapy with either trastuzumab or a small molecule tyrosine kinase inhibitor is being investigated, as a subset of those patients will achieve complete responses without chemotherapy.