Dr. Kimmick on Selecting Adjuvant Therapy for Patients With HER2+ Breast Cancer

Gretchen G. Kimmick, MD, MS, professor of medicine, Duke University School of Medicine, ​member, Duke Cancer Institute, discusses selecting adjuvant therapy for patients with HER2-positive breast cancer.

Patients with low-risk, early-stage, HER2-positive breast cancer often have tumors that are less than 2 cm and do not involve lymph nodes or micrometastases, Kimmick explains. In these patients, particularly those with tumors that are less than 1 cm, several adjuvant therapeutic options are available. These regimens have different treatment schedules and toxicities, so it is important to tailor treatment selection based on the individual patient, according to Kimmick.

For example, a patient who is a musician may not want to risk developing neurotoxicity with chemotherapy, so ado-trastuzumab emtansine (T-DM1; Kadcyla) may be the optimal adjuvant option for them, Kimmick explains. Additionally, a patient whose schedule does not allow them to come into the clinic weekly for treatment may be best suited with docetaxel/cyclophosphamide/trastuzumab (Herceptin) or T-DM1 compared with the APT regimen comprised of weekly paclitaxel followed by 1 year of trastuzumab. Ultimately, however, the APT regimen remains the most utilized adjuvant treatment choice for this patient population, Kimmick concludes.