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Expert Point of View: Steven J. Isakoff, MD, PhD


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“With longer follow-up, the addition of pertuzumab to chemotherapy and trastuzumab appears to show benefit in hormone receptor–­positive patients as well. In practice, we offer this regimen to node-positive patients and we are encouraged that hormone receptor-positive and -negative patients have a benefit,” said Steven J. Isakoff, MD, PhD, medical oncologist at Massachusetts General Hospital Cancer Center, Boston.

Steven J. Isakoff, MD, PhD

Steven J. Isakoff, MD, PhD

“The challenge to incorporating the data from APHINITY is that, today, most patients get neoadjuvant chemotherapy. APHINITY is an adjuvant trial. The field has moved toward neoadjuvant therapy for stage II and higher HER2-positive breast cancer,” Dr. Isakoff noted. 

“In today’s world, we can apply trial results as follows: if there is no pathologic complete response after neoadjuvant therapy, we would give trastuzumab emtansine (T-DM1) based on the KATHERINE trial; if pathologic complete response is achieved, then continue treatment with trastuzumab/pertuzu­mab,” he said.

“It remains unanswered whether patients in pathologic complete response need a whole year of both antibodies or whether trastuzumab is sufficient. Upcoming studies will look at treatment de-escalation or optimization, such as the ALLIANCE COMPASS study. This will be the next era of clinical trials in HER2-positive early breast cancer,” Dr. Isakoff predicted.

“Brain metastases were relatively rare in APHINITY, but they did account for about one-third of distant recurrences. We need to think about better strategies to prevent brain metastases from developing,” he added.

DISCLOSURE: Dr. Isakoff has served in a consulting or advisory role for AbbVie, Genentech/Roche, Hengrui Therapeutics, Immunomedics, Myriad Genetics, and Puma Biotechnology and has received institutional research funding from AbbVie, AstraZeneca/MedImmune, Genentech, Merck, OncoPep, and PharmaMar.

 


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