Dr. Mitri on the Treatment Landscape of HER2+ Breast Cancer

Zahi Mitri, MD, MS, assistant professor of medicine, Oregon Health and Science University (OHSU), discusses the treatment landscape of HER2-positive breast cancer.

The presentation of the NSABP B-47 trial at the 2017 San Antonio Breast Cancer Symposium confirmed that patients who have HER2 amplification are those who benefit from HER2-directed therapy, says Mitri.

The duration of adjuvant therapy for these patients is still 1 year of trastuzumab (Herceptin), says Mitri. The APHINITY trial added pertuzumab (Perjeta) to adjuvant therapy with trastuzumab. Additionally, the ExteNET trial led to the approval of neratinib (Nerlynx) for the extended adjuvant treatment of patients with early stage, HER2-positive breast cancer following postoperative trastuzumab.

In the management of metastatic disease, physicians can use pertuzumab, as well as ado-trastuzumab emtansine (T-DM1; Kadcyla). There are new agents in development that serve as exciting novel anti-HER2 therapies, explains Mitri.

At OSHU, physicians tend to use neoadjuvant therapy. Physicians still give chemotherapy with an anti-HER2 blockade in the neoadjuvant setting. Following surgery, physicians used to complete just 1 year of therapy with trastuzumab. Now, physicians are adding pertuzumab in patients who qualify for it. Neratinib may be considered for patients following 1 year of therapy.