Dr. Traina on Conversations on Extended Adjuvant Therapy With Neratinib in HER2+ Breast Cancer

Tiffany A. Traina, MD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses patient conversations regarding extended adjuvant therapy with neratinib (Nerlynx) in early-stage HER2-positive breast cancer.

Once patients complete a year of adjuvant therapy with either a combination of trastuzumab (Herceptin) and pertuzumab (Perjeta), or ado-trastuzumab emtansine (T-DM1; Kadcyla), it is important that clinicians discuss the potential for extended adjuvant therapy, says Traina. Despite a year of adjuvant therapy, some patients remain at risk of recurrence. For that reason, Traina recommends to have these conversations with patients who have early-stage estrogen receptor-positive, HER2-positive breast cancer.

Neratinib is one agent that can be considered for use as extended adjuvant therapy based on data from the phase III ExteNET trial. Five-year follow-up data from the trial indicated an invasive disease-free survival rate of 90.2% with neratinib versus 87.7% with placebo. Although some patients may be hesitant to continue on another year of adjuvant therapy, the magnitude of benefit is compelling, says Traina. This, coupled with better diarrhea management strategies, should spur the pursuit of shared decision making regarding the use of neratinib, concludes Traina.