Dr. Mitri Discusses Adjuvant Therapy for HER2+ Breast Cancer

Zahi Mitri, MD, MS, assistant professor of medicine, Oregon Health and Science University, discusses adjuvant therapy for patients with HER2-postive breast cancer.

Although the APHINITY showed a statistically significant improvement in disease-free survival with the use of adjuvant pertuzumab (Perjeta), Mitri says that few physicians have changed their treatment regimen to include it. Pertuzumab is often used in the neoadjuvant setting, so the question now is what to do after. Mitri says that he gives pertuzumab for 1 year, sometimes neoadjuvantly and sometimes adjuvantly.

As for neratinib (Nerlynx), the phase III ExteNET trial was positive and led to the FDA approval for this agent in the adjuvant setting. Much of the benefit observed for neratinib was in the estrogen receptor (ER)-positive population. Mitri says that since none of these patients had previously received pertuzumab, there is question of the benefit of neratinib after 1 year of neoadjuvant pertuzumab—which most patients with HER2-positive disease receive.

Mitri says that if a patient who was ER-positive had received neoadjuvant pertuzumab and remained high-risk, he would recommend adjuvant neratinib.