Dr. Ali on Choosing Adjuvant Treatment for HER2+ Breast Cancer

Haythem Y. Ali, MD, senior medical oncologist, Henry Ford Hospital, discusses the adjuvant treatment of patients with HER2-positive breast cancer.

In July 2017, the FDA approved neratinib (Nerlynx) for the extended adjuvant treatment of patients with early stage, HER2-positive breast cancer following postoperative trastuzumab (Herceptin). Following this approval, the FDA approved pertuzumab (Perjeta) in combination with trastuzumab and chemotherapy as an adjuvant treatment for patients with HER2-positive early breast cancer at high risk for recurrence in December 2017.

Clinicians can now choose between 2 adjuvant therapeutic regimens—trastuzumab plus pertuzumab, or neratinib. Both of these are dose-escalation strategies, says Ali, so clinicians should focus on patients who will benefit the most. Focusing on higher-risk patients, the small amount of benefit that adjuvant therapy provides is more impactful, he explains. The question is, which high-risk patients receive which dosage strategy? The subgroup analyses from these trials may help clinicians make their decision, Ali says.