Keypoints:
• Treatment paradigms for early-stage HER2-positive breast cancer, including the APT trial and considerations for neoadjuvant therapy.
• The standard of care for locally advanced disease with TCHP and managing associated toxicities.
• Insights into the latest data from the PATINA trial and its implications for metastatic HER2-positive patients.
• Discussion on the use of T-DXd and other treatment options in the second and third-line settings, especially for patients with brain metastases.
In this episode of the Oncology Brothers podcast, we had the pleasure of welcoming Dr. Sarah Sammons from Dana-Farber Cancer Institute to discuss the treatment landscape for HER2-positive breast cancer. We began by exploring the treatment paradigm for early-stage HER2-positive breast cancer, particularly focusing on tumors less than two centimeters and node-negative cases. Dr. Sammons emphasized the importance of individualized treatment decisions, especially for small tumors, and highlighted the role of patient characteristics such as age and estrogen receptor status in determining the need for neoadjuvant therapy.
As we transitioned to locally advanced disease, Dr. Sammons shared her insights on the standard of care, which is TCHP in the neoadjuvant setting. She discussed the balance between efficacy and toxicity, noting that while TCHP is generally preferred, there are cases where anthracyclines may still be considered. We also touched on the management of side effects associated with TCHP, particularly diarrhea, and the importance of patient education in navigating these challenges.
In the metastatic setting, we discussed the current standard of care, which involves chemotherapy with dual anti-HER2 therapy, and the exciting developments from the PATINA trial, which suggests that combining CDK4-6 inhibitors with ongoing anti-HER2 therapy could significantly improve progression-free survival for triple-positive patients. Dr. Sammons also addressed the treatment options available in the second and third lines, including T-DXd and tucatinib-based regimens, while acknowledging the data-free zone we often find ourselves in for later lines of treatment.
Throughout the episode, we emphasized the need to keep quality of life at the forefront of treatment decisions, as well as the importance of ongoing patient engagement and education. We hope our listeners find this discussion valuable as they navigate the complexities of treating HER2-positive breast cancer. Thank you for tuning in, and be sure to check out our other treatment algorithm discussions!
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