Dr. Gradishar Discusses the Treatment of HER2+ Breast Cancer

William J. Gradishar, MD, interim chief of hematology and oncology, Department of Medicine, Betsy Bramsen Professorship of Breast Oncology, professor of medicine (hematology and oncology), Northwestern University's Feinberg School of Medicine, discusses the treatment of patients with HER2-positive breast cancer.

There are some patients who are not candidates for chemotherapy, or cannot tolerate it due to other medical comorbities, says Gradishar. Other options for these patients would be giving both hormonal therapy and HER2-targeted therapy simultaneously, such as lapatinib (Tykerb) and letrozole or anastrozole and trastuzumab (Herceptin).

More recently, dual targeting of HER2 along with an hormonal therapy has shown promise as a treatment for these patients. The phase III results from the ALTERNATIVE trial showed the median progression-free survival was 11 months (95% CI, 8.3-13.8) for postmenopausal women with hormone receptor-positive, HER2-positive metastatic breast cancer assigned to lapatinib plus trastuzumab plus an aromatase inhibitor (AI) compared with 5.7 months (95% CI, 5.5-8.4) for patients assigned to trastuzumab plus an AI.

There has also been work looking at combining hormonal therapy with CDK 4/6 inhibitors and HER2-targeted therapy, Gradishar adds.