The Fellow on Call: The Heme/Onc Podcast Episode 063: Breast Cancer Series, Pt. 8-HER2+, Early Stage Breast Cancer
Jul 5, 2023
Dive into the fascinating world of HER2+ early stage breast cancer. Discover the biology behind HER2 and the groundbreaking origins of trastuzumab. Explore the pivotal trials that highlight the survival benefits of various treatments. Learn about the innovative TCHP regimen and its impact on cardiotoxicity. Uncover management strategies for small tumors and how to approach residual disease with T-DM1. Get equipped with practical algorithms to enhance decision-making in treatment.
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Trastuzumab Improved Adjuvant Outcomes
- Early adjuvant trials (NSABP B31 and N9831) showed adding trastuzumab to chemo improved 3-year DFS by ~12%.
- Targeting HER2 upfront transformed prognosis in early-stage HER2-positive breast cancer.
Prefer Neoadjuvant Therapy For Higher-Risk Tumors
- Use neoadjuvant HER2-directed chemo for tumors >2 cm or node-positive disease to downstage and assess pathologic complete response.
- Higher pathologic CR rates guide adjuvant treatment and can inform escalation to agents like T-DM1 if residual disease remains.
Pertuzumab Raises pCR, Less So If ER+
- Adding pertuzumab to trastuzumab increases neoadjuvant pathologic complete response rates, especially in HER2+/ER- tumors.
- ER-positive/HER2-positive tumors have lower pCR rates compared with ER-negative/HER2-positive tumors.