What adjuvant systemic therapy would you recommend for a premenopausal woman with a germline BRCA mutation who initially presented with locally advanced, HR+, HER2-negative (FISH) IDC, but was later found on surgical pathology to have HR+, HER2+ disease (IHC 3+) after neoadjuvant chemotherapy?
Initially, presented with cT2N3M0 IDC, ER/PR+, HER2 negative (FISH) on pre-operative biopsies (breast and axilla) → Got neoadjuvant AC-T → Later found to have ER+, HER2+ (IHC 3+) disease on surgical pathology with a large burden of residual disease.
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What adjuvant HER2 therapy, if any, would you recommend for a premenopausal woman with locally advanced, node positive ER+ HER2- breast cancer s/p neoadjuvant therapy found to have residual ER+ HER2+ disease?
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2 Answers
Mednet MemberInvited Expert
Medical Oncology · Ohio State University
Answered on
In a situation like this, I would consider 1 year of adjuvant trastuzumab and pertuzumab. The HERA study showed the benefit of adding trastuzumab after a full course of adjuvant chemotherapy for HER2+ breast cancer, which would provide some (although imperfect) evidence to support such an approach. ...
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Mednet MemberInvited Expert
Medical Oncology · University of Utah Huntsman Cancer Institute
Answered on
Agree with adjuvant HER2-targeted therapy. This is an unusual situation. Tarantino et al reported data on 1,080 patients treated at Dana Farber/Brigham Cancer Center from 2016-2022 who had residual disease after neoadjuvant chemotherapy. Of the 808 cancers that were HER2 0 or HER2-low on pre-op biop...
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