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Physicians’ Education Resource®, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

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Medical Crossfire®: Leveraging New Evidence in the Context of Evolving Early-Stage Treatment Standards in HER2-Positive Breast Cancer PER Pulse™ Recap

PER Pulse Recap

PER Pulse™ Recap



1 of 3
PER Pulse Recap

Medical Crossfire®: Leveraging New Evidence in the Context of Evolving Early-Stage Treatment Standards in HER2-Positive Breast Cancer featured nationally recognized experts in breast cancer. Program Chair Joyce O’Shaughnessy, MD, along with faculty, William Gradishar, MD; Mark Pegram, MD, PhD; and Linda Vahdat, MD, MBA, discussed challenges encountered by clinicians treating patients with early-stage HER2-positive breast cancer, exchanged perspectives on unmet needs, offered suggestions for optimizing care, and reviewed current and emerging standards of care in this setting.

This first of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on a panel discussion of high-risk, HER2-positive patient populations. Below are some points of discussion from this expert panel:

  • Significant residual disease after optimal preoperative therapy is always a clinical concern.
  • HER2-positive breast cancers are highly heterogeneous.
  • Approximately half of HER2-positive breast cancers are hormone-receptor (HR)-positive.
  • Pathological complete response rates (pCR) after neoadjuvant antiHER2 therapy are lower among patients with hormone receptor (HR)-positive disease. In contrast, data from trials of adjuvant antiHER2 therapy did not show a difference in disease-free survival by HR status, even with extended follow-up. This may be a result of adjuvant hormonal therapy received by patients with ER-positive disease.
    • The NSABP B-52 trial aims to evaluate whether estrogen deprivation therapy added to neoadjuvant docetaxael, anthracycline, carboplatin, and pertuzumab (TCHP) will improve pCR (breast and nodes), versus TCHP alone in women with operable, hormone-receptor-positive, HER2-positive breast.
  • Analysis of HER2-positive tumor samples to assess intrinsic subtype and clinical outcomes revealed that approximately 70% of clinically-defined HER2-positive tumors were classified as HER2-enriched by genome expression profiling. Most of the remaining tumors were luminal-type, with approximately 7% identified as basal-like. Patients with basal-like tumors had the worst outcomes.
  • Other studies are using differences in so-called immune signatures of HER2-positive breast tumors to make correlations with response to HER2-targeted therapy.

For more on this discussion, visit https://education.gotoper.com/activity/cfs16mcfbreast



2 of 3
PER Pulse™ Recap

Medical Crossfire®: Leveraging New Evidence in the Context of Evolving Early-Stage Treatment Standards in HER2-Positive Breast Cancer featured nationally recognized experts in breast cancer. Program Chair Joyce O’Shaughnessy, MD, along with faculty, William Gradishar, MD; Mark Pegram, MD, PhD; and Linda Vahdat, MD, MBA, discussed challenges encountered by clinicians treating patients with early-stage HER2-positive breast cancer, exchanged perspectives on unmet needs, offered suggestions for optimizing care, and reviewed current and emerging standards of care in this setting.

This second of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on a panel discussion of HER2 testing. Below are some points of discussion from this expert panel:

  • Academic centers receive many referrals for patients with HER2 equivocal test results.
  • Major complexities and heterogeneities may exist among tumors deemed HER2 equivocal. For example, just a small fraction of cells may be highly amplified or, in some cases, deletion of the chromosome 17 (CEP17) centromere control may result in an inflated ratio.
  • Due to nuances in testing and results such as these, it is advisable to have an academic pathology expert review the most challenging cases.
  • Use of an alternative probe (eg, SMS/RARA) may reveal HER2 positivity.
  • Dr. Gradishar commented that in cases of unresolved uncertainty, his institution trends toward treating with antiHER2 therapy versus not.
  • The ASCO/CAP guidelines recommend that reflex testing should be performed using an alternative assay (IHC or ISH) in the event of an equivocal test result.

For more on this discussion, visit https://education.gotoper.com/activity/cfs16mcfbreast


3 of 3
PER Pulse™ Recap

Medical Crossfire®: Leveraging New Evidence in the Context of Evolving Early-Stage Treatment Standards in HER2-Positive Breast Cancer featured nationally recognized experts in breast cancer. Program Chair Joyce O’Shaughnessy, MD, along with faculty, William Gradishar, MD; Mark Pegram, MD, PhD; and Linda Vahdat, MD, MBA, discussed challenges encountered by clinicians treating patients with early stage, HER2-positive breast cancer, exchanged perspectives on unmet needs, offered suggestions for optimizing care, and reviewed current and emerging standards of care in this setting.

This third of 3 PER Pulse™ Recaps from this Medical Crossfire® focuses on panel discussion of emerging strategies for early-stage HER2-positive breast cancer. Below are some key points of discussion from this expert panel:

  • Approximately 25% to 30% of patients who receive adjuvant HER2-targeted therapy experience relapse of their disease.
  • Extended adjuvant therapy with a tyrosine kinase inhibitor after an antiHER2 antibody represents a new treatment paradigm that is likely to be further developed in coming years.
  • Dr. Pegram commented that the positive results of the ExteNET trial are remarkable considering how well the control arm did in that study, and that although the absolute differences in invasive disease-free survival across the study arms was small in magnitude, the hazard ratio was impressive.
  • If approved, decisions on whether to use neratinib will need to include case-by-case discussions with patients about the risks for recurrence versus toxicity.
  • Based on existing trial data, the panel could foresee using neratinib for patients at high risk for recurrence (for example, bulky locally advanced disease, extensive lymph node involvement, residual disease after neoadjuvant therapy).
  • Education of physicians and patients regarding toxicity management will lend to success.

For more on this discussion, visit https://education.gotoper.com/activity/cfs16mcfbreast





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