Should neoadjuvant chemotherapy be recommended for HER2+, clinically LN- breast cancer measuring 2-3cm?

Topics: Breast Cancer • Medical Oncology • NCI-CCC Tumor Board Question • Her2+ • University of Utah

If yes, would you still recommend dual HER2 directed therapy?

After the TRYPHAENA trial, neoadjuvant therapy with dual HER2 directed therapy has become the standard approach for HER2+, localized tumor if tumor> 2cm or LN+. The 7 yr update from APT trial (Tolaney et al), reported excellent DFS, OS and RFI for tumors <=3cm. However, that trial only has 36 patients with tumor 2-3cm.

Answer from: Medical Oncologist at Academic Institution

For cT2N0 2-3 cm HER2+ tumors I am still doing neoadjuvant dual blockade chemotherapy for eligible patients in order to assess their pCR status. This guides adjuvant therapy per the KATHERINE study. I usually reserve the APT approach for cT1N0 patients who go to surgery first and are still a stage 1...

Comments

Medical Oncologist at Heartland Cancer Center
In these patients cT2 (2-3 cm) N0, if they achieve...

Medical Oncologist at Clinical Instructor
This recent thread addresses whether or not to con...

Answer from: Medical Oncologist at Community Practice

Given excellent results and follow up of APT trial, I prefer paclitaxel and trastuzumab in tumors up to 3 cm. I do not want to give pertuzumab and expose patient to toxicity.

Comments

Medical Oncologist at Mayo Clinic Rochester
While patients with up to 3 cm were eligible for t...

Medical Oncologist at H Lee Moffitt Cancer Center, University of South Florida
I agree with @Amye Tevaarwerk on this. The mi...

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