The Role of Maintenance Therapy in HER2+ Breast Cancer

Video

Dr Sarah M. Tolaney discusses whether maintenance therapy has a role in HER2+ breast cancer treatment.

Sarah M. Tolaney, MD, MPH: When I think about maintenance therapy, I think about 2 different settings. One would be the metastatic setting looking at HP [trastuzumab, pertuzumab] maintenance, and [the other] someone who got induction THP [docetaxel, trastuzumab, pertuzumab] for first-line metastatic HER2 [human epidermal growth factor receptor 2]–positive disease. But I also think about maintenance in the early stage setting after someone achieved a PCR [pathologic complete response], and you’re getting your HP [trastuzumab, pertuzumab] to complete your year of therapy.

In the early stage setting, it’s very formulaic that you get your preoperative treatment and then you’re on HP [trastuzumab, pertuzumab] to complete a year. But in the metastatic setting, it’s a little more of an art than a science: when do you stop your induction therapy before going on to the maintenance approach? The data suggest that most people tend to get 6 to 8 cycles of induction taxane; many people are stopping after achieving robust responses. Some are stopping when patients are starting to develop some toxicity, such as neurotoxicity, and some doctors are going a little longer to make sure that response is a little more durable. It’s a little variable how we approach that.

With the maintenance setting and the metastatic setting, I tend to add endocrine therapy if that patient has ER [estrogen receptor]–positive, HER2+ disease to enhance that maintenance approach. We have some data to do this based on the data from PERTAIN, which looked at AI [aromatase inhibitor] therapy with either trastuzumab or trastuzumab with pertuzumab, and showed great outcomes with the AI–HP [trastuzumab, pertuzumab] combination. A lot of trials are ongoing trying to look at this maintenance setting to see if we can even do better. One example is PATINA, which looked at adding CDK4/6 inhibition with palbociclib [Ibrance] to the maintenance. We have an ongoing trial looking at adding tucatinib [Tukysa] to this maintenance setting, to see if we can help prolong disease control and maybe even prevent CNS [central nervous system] metastases. It’s a nice setting to think about novel ways to improve outcomes further.

Transcript edited for clarity.

Recent Videos
The use of chemotherapy trended towards improved recurrence-free intervals in older patients with high-risk tumors as determined via the MammaPrint assay.
Use of a pharmacist-directed resource appears to improve provider confidence and adverse effect monitoring for patients undergoing infusion therapy.
Reshma L. Mahtani, DO, describes how updates from the DESTINY-Breast09, ASCENT-04, and VERITAC-2 trials may shift practices in the breast cancer field.
Multidisciplinary care can help ensure that treatment planning does not deviate from established guidelines for inflammatory breast cancer management.
Photographic and written documentation can help providers recognize inflammatory breast cancer symptoms across diverse populations.
The use of guideline-concordant care in breast cancer appears to be more common in White populations than Black populations.
Strict inclusion criteria may disproportionately exclude racial minority populations from participating in breast cancer trials.
Related Content