Dr Tarantino on Advances Allowing for Tailored Treatment in HER2+ Breast Cancer

Paolo Tarantino, MD, researcher, the European Institute of Oncology, clinical research fellow, Dana-Farber Cancer Institute, discusses advancements that may lead to more tailored treatment approaches in early-stage HER2-positive breast cancer.

Unlike many other cancers where treatment personalization remains challenging, the integration of multiple therapeutic options into the treatment paradigm, coupled with a deeper understanding of both biological and imaging biomarkers, has positioned HER2-positive early-stage breast cancer as a model for personalized medicine, Tarantino begins.

A variety of options are available in the HER2-positive treatment arsenal, ranging from anthracycline-based regimens to non-anthracycline alternatives, including carboplatin and taxane-based treatments, Tarantino details. Trastuzumab (Herceptin) and pertuzumab (Perjeta) have been central to these advancements, he adds. Additional options include TKIs and the potential escalation of treatment using trastuzumab emtansine (Kadcyla; T-DM1). The goal is to optimize treatment by using the least amount necessary to prevent recurrence, reducing overtreatment and minimizing adverse effects, Tarantino explains.

A deeper understanding of biomarkers is also emerging, he continues. The HER2DX assay, which examines the genomic signature of HER2 amplification, proliferation, and luminal characteristics, is helping to refine treatment decisions. In addition, imaging biomarkers, like PET scans and MRI, are becoming more integrated into clinical practice, he notes. With this growing body of data, clinicians are better equipped to use a combination of biomarkers and therapies to minimize the amount of treatment needed to prevent recurrence while maximizing effectiveness, Tarantino explains.

Another important strategy being adopted is the use of neoadjuvant treatment, he states. This approach allows clinicians to identify patients who do not achieve a pathologic complete response, enabling them to escalate post-neoadjuvant treatment and tailor further care, Tarantino details. These advancements in HER2-positive breast cancer are shaping a more personalized and precise treatment landscape, he concludes.