Dr. Krop on the Role of Neratinib as Extended Adjuvant Therapy in HR+/HER2+ Breast Cancer

Ian E. Krop, MD, PhD, an associate professor of medicine​, Harvard Medical School​, associate chief, Division of Breast Oncology​, Susan F. Smith Center for Women's Cancers​, medical oncologist and clinical research director​, Breast Oncology Center​, Dana-Farber Cancer Institute, discusses the role of neratinib (Nerlynx) as extended adjuvant therapy in high-risk, hormone receptor (HR)–positive, HER2-positive breast cancer.

​Currently, neratinib is used as extended adjuvant therapy in patients with HR-​positive, HER2-positive breast cancer, says Krop.

 However, ​pertuzumab (Perjeta) has clouded the utility of neratinib​, says Krop. ​Patients enrolled in the ​phase 3 ExteNET study, whichdemonstrated benefit with neratinib ​as extended adjuvant therapy in patients ​with HER2-positive disease, had not received prior pertuzumab​.

Further, adding ado-trastuzumab emtansine (T-DM1; Kadcyla) to the ​armamentarium further complicates treatment selection, Krop explains.

Additionally, as shown in the phase 3 KATHERINE trial, a large proportion of high-risk patients who have multiple ​positive lymph nodesprogress on T-DM1, Krop adds.

As such, in high-risk patients with HR-​positive, HER2-positive disease, neratinib ​should be considered as extended adjuvant therapy. However, this ​treatment decision is more challenging to justify in the lower-risk patient populations, Krop concludes.