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
Paolo Tarantino, MD, discusses the potential utility of agents such as datopotamab deruxtecan and enfortumab vedotin in patients with breast cancer.
Paolo Tarantino, MD, highlights strategies related to screening and multidisciplinary collaboration for managing ILD in patients who receive T-DXd.
Pegulicianine-guided breast cancer surgery may allow practices to de-escalate subsequent radiotherapy, says Barbara Smith, MD, PhD.
Barbara Smith, MD, PhD, spoke about the potential use of pegulicianine-guided breast cancer surgery based on reports from the phase 3 INSITE trial.
Carey Anders, MD, an expert on breast cancer
Related Content