Dr. Hurvitz on HER2-Targeted Therapies in Breast Cancer

Sara A. Hurvitz, MD, director of the Breast Oncology Program, medical director of the Clinical Research Unit, University of California, Los Angeles Jonsson Comprehensive Cancer Center, discusses HER2-targeted therapies for the treatment of breast cancer.

There are 2 recently FDA-approved HER2-targeted therapies, neratinib (Nerlynx) and pertuzumab (Perjeta). Hurvitz says the challenge lies in figuring out which patients need which agent. Neratinib is associated with significant gastrointestinal (GI) toxicity. Diarrhea is an issue, so patients treated with this drug also need to consider anti-diarrheal medication. Patients also need to be carefully educated on how to contact their doctor if they're experiencing any issues. Hurvitz says this toxicity profile needs to be strongly considered; for example, she wouldn't give neratinib to a patient with pre-existing GI problems, or to someone with low-risk disease who is unlikely to derive any benefit.

Similarly, pertuzumab is associated with GI toxicities as well as febrile neutropenia, Hurvitz adds. In terms of the risk-reduction seen with the addition of neratinib to HER2-targeted treatment, patients can expect an improvement of 20% or higher. Data show that patients with hormone receptor-positive, HER2-positive breast cancer can derive even more benefit.