Dr D'Abreo on HER2-Targeted Therapies in HER2+ Breast Cancer

Nina D'Abreo, MD, assistant professor, Department of Medicine, New York University Grossman School of Medicine, chief, Division of Hematology and Medical Oncology, Perlmutter Cancer Center, discusses the integration of HER2-directed antibodies and targeted therapies into the treatment armamentarium for patients with HER2-positive breast cancer.

Since the early stages of examining adjuvant therapies for patients with HER2-positive breast cancer, there has been a shift in treatment approaches because of the introduction of HER2-directed antibodies, as well as the introduction of targeted therapies, D'Abreo begins. HER2-directed antibodies have redefined the way oncologists address treatment decisions for patients with HER2-positive breast cancer, she explains, adding that these agents have positively affected the prognosis of patients with this disease. These agents’ role primarily involves complementing or augmenting traditional chemotherapy, which still serves as the fundamental component of standard HER2-targeted treatment regimens, D'Abreo explains.

At present, the oncology landscape is advancing toward a more nuanced cancer management strategy that seeks to leverage the advantages of chemotherapy alongside the antibodies and antibody-drug conjugates (ADCs) that have been introduced into this domain, D'Abreo expands. Rather than merely enhancing traditional chemotherapy agents with HER2-directed antibodies, the field is exploring the potential for replacing or substituting these agents with ADCs in select cases, she states. Notably, it is important to understand that there are also targeted therapies available that operate in the HER2 downstream signaling pathway, including TKIs and orally administered HER2 inhibitors, D'Abreo says. These targeted therapies that are now being introduced into the treatment landscape include agents such as fam-trastuzumab deruxtecan-nxki (Enhertu).

Consequently, the breast cancer field is actively investigating opportunities to synergize chemotherapy with these novel treatments for certain patients, D'Abreo continues. Simultaneously, there is a growing interest in the potential to replace chemotherapy with non-chemotherapeutic alternatives in specific instances, emphasizing the versatility and evolution of the therapeutic approaches available for patients with HER2-positive breast cancer, D'Abreo concludes.