Hormonal and HER2-Targeted Therapy in Early Breast Cancer

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Moderator, Debu Tripathy, MD, introduces the panel for a unique discussion that features peer-to-peer expert exchange, authoritative insights, opinions, and perspectives on important issues facing today’s cancer care professionals. The expert panel includes: William J. Gradishar, MD, Joyce A. O’Shaughnessy, MD, Christy A. Russell, MD, and Linda T. Vahdat, MD.

In this section, the panel discusses the current role of HER2 targeted therapies in the treatment of early stage breast cancer, particularly the management of T1N0 breast cancer.

O'Shaughnessy begins by describing the treatment methods that she uses for the various subtypes and grades of early breast cancer. She believes that the most difficulty comes with treating T1a and T1b sized tumors. In general, the treatment paradigm includes trastuzumab and chemotherapy plus an endocrine or hormonal therapy, depending on the hormone receptor (HR) status. Russell adds that for low-risk or elderly patients with breast cancer who are HR-positive she will commonly administer hormonal therapy alone plus trastuzumab, to spare the side effects of chemotherapy.

Research is currently examining the optimal duration of treatment with trastuzumab. Russell describes the recent results from the HERA trial, which did not show a benefit for providing adjuvant trastuzumab for longer than one year. Additionally, an update of the PHARE trial showed that one year of trastuzumab was superior to 6 months. These trials both seem to indicate that one year of trastuzumab should remain the standard of care.