Dr. Hurvitz on How to Navigate HER2-Targeted Therapy in Breast Cancer

Sara A. Hurvitz, MD, director of the Breast Oncology Program at the University of California, Los Angeles, Jonsson Comprehensive Cancer Center, advises how to navigate therapy for patients with HER2-positive breast cancer.

The field of HER2-positive breast cancer has undergone immense change over the last few years. 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). Five months later, 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.

Hurvitz says that with all these new agents, navigating through the options has become tricky. Neratinib is associated with significant gastrointestinal toxicity, particularly diarrhea. Hurvitz says that patients need to be premedicated with antidiarrheals and carefully educated on how to get in touch with their doctor. Pertuzumab also adds some toxicity, particularly an increase in diarrhea and poses a potential for febrile neutropenia. Patients on either of these medications should be monitored closely, Hurvitz advises.