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

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.