Dr Waks on Unmet Needs in Patients With HER2+ Breast Cancer

Adrienne G. Waks, MD, physician, associate director of Clinical Research, Dana-Farber Cancer Institute, instructor in medicine, Harvard Medical School, discusses the need for more personalized approaches in the treatment of patients with HER2-positive breast cancer.

At the 2024 ASCO Annual Meeting, Waks and colleagues presented data on the prevalence and dynamics of circulating tumor DNA (ctDNA) in patients with stage II and III HER2-positive breast cancer from the single arm, phase 2 DAPHNe trial (NCT03716180). In DAPHNe, patients were treated with a combination of neoadjuvant paclitaxel, trastuzumab (Herceptin) and pertuzumab (Perjeta), Waks details.

In the context of early-stage HER2-positive breast cancer, there is a significant unmet need for more personalized approaches to treatment, Waks states. Currently, physicians can choose to administer extensive chemotherapy and multiple HER2-targeted drugs; on the other hand, they can opt for minimal chemotherapy or solely HER2-targeted therapies depending on individual and disease factors, she states. Although the arsenal of treatment options continues to expand in this setting, the primary issue is determining how to tailor treatments to individual patients, Waks emphasizes.

There is a critical need to identify which patients require the most intensive treatment to achieve optimal outcomes and which patients could benefit from less aggressive therapy, thereby avoiding unnecessary treatment-related toxicity, Waks explains. The findings from the DAPHNe trial, particularly the data on ctDNA dynamics, may help address this need. By understanding the prevalence and changes in ctDNA levels, clinicians may be able to better stratify patients based on their risk and response to therapy, ultimately leading to more personalized and effective treatment strategies. The ability to monitor ctDNA could also provide valuable insights into tumor biology and response to treatment, enabling oncologists to adjust therapies in real-time. This approach could ensure that patients who are likely to benefit from more intensive treatment receive it.