Dr. Pegram on Sequencing Therapies in HER2-Positive Breast Cancer

Mark D. Pegram, MD, director, Breast Cancer Oncology Program, Stanford Cancer Institute, discusses contemporary sequencing of therapies for HER2-positive breast cancer.

It can be challenging to cycle through and properly sequence the targeted therapies for this specific tumor type, Pegram explains. The MARIANNE trial randomized patients to chemotherapy and trastuzumab versus T-DM1 and a placebo versus T-DM1 and pertuzumab, which resembles the regimen from the CLEOPATRA study. Pegram says the efficacy remained similar between the three arms.

However, the superiority endpoint of the T-DM1 plus pertuzumab arm was not met, nor was there any T-DM1 superiority compared to chemotherapy or trastuzumab.

The CLEOPATRA regimen, with pertuzumab in the advanced disease setting, is the preferred regimen for Pegram.