Dr D'Abreo on Leveraging Biology When Treating 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 her presentation from an OncLive® State of the Science Summit™ on breast cancer, during which she discussed the treatment of patients with HER2-low and HER2-positive breast cancer.

The transformative advancements in the treatment of patients with HER2-positive cancer have presented oncologists with the challenge of effectively utilizing the wealth of available data, she begins. In D'Abreo’s presentation, she emphasized 3 key aspects for tailoring treatment for patients with early-stage HER2-positive breast cancer: leveraging biology, considering clinical risk factors, and prioritizing patient safety in terms of toxicity.

Addressing clinical risk involves considering traditional disease factors, such as tumor size and lymph node status, supported by pertinent data, D'Abreo expands. Biological risks include genomic risks, which can be measured through the radiological assessment of PCR results and offer predictive insights regarding which patients may respond to which treatments, she states. Significantly, toxicity considerations encompass adverse effects (AEs), financial implications, and time-related challenges, emphasizing the need for a holistic approach to patient care, D'Abreo notes.

When oncologists are faced with a multitude of treatment options, D’Abreo says it is important to consistently prioritize 2 equally significant aspects. Firstly, evidence is crucial as oncologists aim to achieve the best outcomes for patients. For example, for patients with residual disease in the adjuvant setting, the effectiveness of antibody-drug conjugates, such as ado-trastuzumab emtansine (T-DM1; Kadcyla) and fam-trastuzumab deruxtecan-nxki (Enhertu) is well established, leading to a shift away from using trastuzumab (Herceptin) and pertuzumab (Perjeta), as supported by robust data from the phase 3 KATHERINE trial (NCT01772472), she elucidates.

Although improving patient outcomes is imperative, equally crucial is considering the toxicity implications of available therapies, D'Abreo notes. Plans to treat a patient with an effective agent, such as TDM-1, may be hindered if a patient experiences AEs, such as significant neuropathy. Thus, the treatment decision-making process involves carefully assessing the toxicity profiles of individual drugs. Overall, both the strength of efficacy evidence and the potential for toxicity play pivotal roles in guiding breast cancer treatment choices, ensuring a comprehensive treatment approach that prioritizes both efficacy and patient well-being, D'Abreo concludes.