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Therapy for High-Risk HER2+ EBC

CE / CME

Planning Therapy for High-Risk HER2-Positive Early-Stage Breast Cancer: Expert Viewpoint

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: May 12, 2021

Expiration: May 11, 2022

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 (HER2+) early-stage breast cancer (EBC) management, including risk assessment, strategies for neoadjuvant and extended adjuvant therapy to manage patients with 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 healthcare professional, how many patients with breast cancer do you provide care for in a typical month?

A 52-year-old woman initially presented with clinical cT1cN0M0 breast cancer and testing revealed estrogen receptor (ER) positivity of 90%, progesterone receptor (PgR) positivity of 80%, and Ki-67 of 50%; HER2 3+ by immunohistochemistry; and HER2/neu positive by fluorescence in situ hybridization amplification. Lumpectomy and sentinel lymph node (LN) biopsy revealed a 2.2-cm ER/PgR-positive, HER2+ breast cancer. All 3 sentinel LNs were positive for disease, with the largest LN deposit being an 8-mm metastasis.

In your current clinical practice, in addition to standard endocrine therapy, which of the following adjuvant chemotherapy regimens would you recommend for this patient?

Our 52-year-old woman with clinical cT1cN0M0 breast cancer underwent lumpectomy and sentinel LN biopsy, which revealed a 2.2-cm ER/PgR-positive, HER2+ breast cancer. All 3 sentinel LNs were positive for disease with the largest LN deposit being an 8-mm metastasis. Following surgery, she was treated with adjuvant TCHP plus endocrine therapy.

In your current clinical practice, which of the following would you recommend after the patient completes her course of chemotherapy?

Our 52-year-old woman with clinical cT1cN0M0 breast cancer underwent lumpectomy and sentinel LN biopsy, which revealed a 2.2-cm ER/PgR-positive, HER2+ breast cancer. All 3 sentinel LNs were positive for disease, with the largest LN deposit being an 8-mm metastasis.

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

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

A 49-year-old woman presents with cT2cN1M0 disease that was hormone receptor negative (by immunohistochemistry) and HER2 positive (by fluorescence in situ hybridization). 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 LNs 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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