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HER2+ EBC: Evolution

CE / CME

The Evolving Therapeutic Landscape for HER2-Positive Early-Stage Breast Cancer

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: Maximum of 1.00 AMA PRA Category 1 Credit™

Nurses: 1.00 Nursing contact hour

Released: August 10, 2020

Expiration: August 09, 2021

Lee Schwartzberg
Lee Schwartzberg, MD
CME/CE Information

Activity

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In this module, Lee Schwartzberg, MD, FACP, provides an overview of the current status of HER2-positive early-stage breast cancer (EBC) management, including risk assessment, strategies for neoadjuvant and adjuvant therapy to manage patients with lower-risk or high-risk disease, and safety considerations with HER2-targeted agents.

The key points discussed in this module are illustrated with thumbnails from an accompanying downloadable PowerPoint slideset that can be found here or downloaded by clicking any of the slide thumbnails in the module alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. Several questions will be asked twice: once at the beginning of the activity, and then once again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

If you are a practicing clinician, how many patients with breast cancer do you provide care for in a typical month?

A 48-year-old woman presents with clinical cT1cN0M0 breast cancer. Testing reveals ER positive of 90%, PgR positive of 80%, Ki-67 of 50%, and HER2 3+ by IHC, HER2/neu by FISH amplification positive. Lumpectomy and sentinel lymph node biopsy revealed a 2.6-cm ER/PgR–positive, HER2-positive breast cancer. Two of 3 sentinel lymph nodes (LNs) were positive disease, with the largest LN deposit being an 8-mm metastasis.

In your current clinical practice, in addition to standard endocrine therapy, what adjuvant chemotherapy would you recommend for this patient?

Our 48-year-old woman with clinical cT1cN0M0 breast cancer underwent lumpectomy and sentinel lymph node biopsy, which revealed a 2.6-cm ER/PgR-positive, HER2-positive breast cancer. Two of 3 sentinel LNs were positive disease with the largest LN deposit being an 8-mm metastasis. Following surgery, she was treated with adjuvant docetaxel/carboplatin/trastuzumab/pertuzumab plus endocrine therapy.

In your current clinical practice, what would you recommend after the patient completes chemotherapy?

Our 48-year-old woman with clinical cT1cN0M0 breast cancer underwent lumpectomy and sentinel lymph node biopsy, which revealed a 2.6-cm ER/PgR-positive, HER2-positive breast cancer. Two of 3 sentinel LNs were positive disease with the largest LN deposit being an 8-mm metastasis.


Following surgery, she was treated with adjuvant docetaxel/carboplatin/trastuzumab/pertuzumab plus endocrine therapy. She completed 1 year of trastuzumab and pertuzumab with minimal AEs other than mild diarrhea. Now, she has come to the clinic to discuss extended adjuvant therapy with neratinib.

In your consultation with your patient, which of the following should you tell her regarding neratinib-induced diarrhea?

A 51-year-old woman presents with cT2cN1M0 disease that was hormone receptor negative (by IHC) and HER2 positive (by FISH). She received neoadjuvant AC→THP followed by surgery. At surgery, she is found to have residual disease in her breast (1 cm) and LN (1 of 12 LN with 1.2-cm focus). The residual disease remains hormone receptor negative and HER2 positive.

In your current clinical practice, what adjuvant therapy would you recommend for this patient?
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