Should neoadjuvant chemotherapy be recommended for HER2+, clinically LN- breast cancer measuring 2-3cm?
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.
2 Answers
Mednet MemberInvited Expert
Medical Oncology · H Lee Moffitt Cancer Center, University of South Florida
Answered on
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...
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Mednet Member
Medical Oncology · NYU Winthrop Hospital
Answered on
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.
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