Dr. Hamilton on the Optimal Duration of Trastuzumab in HER2+ Breast Cancer

Erika P. Hamilton, MD, director, Breast and Gynecologic Research Program, Sarah Cannon Research Institute, discusses the optimal duration of trastuzumab (Herceptin) in patients with HER2-positive breast cancer.

One of the major areas of investigation in HER2-positive breast cancer is determining the optimal duration of therapy, specifically with regard to trastuzumab, explains Hamilton. The HERA, PERSEPHONE, and PHARE trials have all tried to define the most beneficial length of trastuzumab. Based on results from the HERA trial, physicians learned that 2 years of trastuzumab is not more beneficial than 1 year.

However, data from the PHARE and PERSEPHONE trials had conflicting results, says Hamilton. Final results of the PHARE trial showed that a shorter, 6-month duration of trastuzumab failed to be noninferior to the standard 12-month course of therapy, whereas 5-year follow-up from the PERSEPHONE trial demonstrated noninferiority between the 2 durations. Taken collectively, Hamilton says that 1 year of therapy is likely more effective than 6 months, although the decision should be individualized to each patient.

For patients with comorbidities, elderly patients, and those who have trouble traveling, 6 months of therapy may be a suitable option. For the average patient, Hamilton recommends sticking with 12 months of therapy.