Expert Overview of HER2-Positive Breast Cancer Treatment

Treatment for HER2-positive breast cancer depends on staging and can be intensified or de-escalated depending on disease characteristics, explained Dr. Debu Tripathy.

READ MORE: HER2 an ‘Actionable Biomarker’ in Breast Cancer Subset

Tripathy is a professor of medicine and chair in the department of breast medical oncology at The University of Texas MD Anderson Cancer Center, as well as the editor-in-chief at CURE®. At the Miami Breast Cancer Conference, he sat down and explained an overview of HER2-positive breast cancer treatment. He discussed how clinicians use HER2-targeting antibodies like Herceptin (trastuzumab) and Perjeta (pertuzumab) — among other drugs — for this patient population.


For patients who have clinical stage 1 breast cancer, they will go to surgery first. If they maintain stage 1 [after surgery] based on the lymph node assessment, then we use the de-escalated therapy — the so-called PP regimen — of weekly paclitaxel for 12 weeks given with [Herceptin]. Then the [Herceptin] continues for a full year, so an additional 40 weeks. During that time, if the tumor is hormone receptor-positive they will be on endocrine therapy. This has allowed us to use less-toxic treatments.

On the other hand, if a patient presents with greater than clinical stage 2, so [their tumor is at least] two centimeters or positive nodes, then we use neoadjuvant therapy. This allows us to downstage the tumor and may allow less surgery or more conservative surgery, a higher rate of breast-preserving surgery and maybe even fewer lymph nodes that may also affect not only the extent of surgery but radiation as well.

Typically, the regimens that we’re using here are a little more escalated. A taxane along with dual antibody therapy, both [Herceptin] and [Perjeta] is used. Some people are still using platinum[-based chemotherapy]. [This is known as the] TCHP regimen, so docetaxel or paclitaxel, along with carboplatin and [Herceptin] and [Perjeta]. It’s not clear how much the platinum is contributing. We’ve never done randomized trials to see if we can exclude it, but many people are excluded due to the toxicities or at least that’s the first one that would be discontinued with toxicities.

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