Would you consider dual anti-HER2 therapy for a perimenopausal woman found to have multifocal pT1mic pN1mic HER2+ HR- breast cancer following a bilateral mastectomy for DCIS?

Topics: Breast Cancer • Medical Oncology • Breast Cancer, Non-metastatic

For instance, the foci found were pN1mi (0.5 mm) deposit in 1st SNL (1/13 LN) and mpT1mi (8 foci). Would you consider single or dual anti-HER2 blockade along with taxane?

Answer from: Medical Oncologist at Academic Institution

The optimal treatment for DCIS with microinvasion DCISm is not fully established. There is a nice analysis and discussion from Si et al., PMID 33344258 outlining the factors for worse outcomes. Her multifocality, ER-HER2+ status, and most importantly, nodal involvement increases her risk compared to...

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Medical Oncologist at Onc San Antonio
Thank you for the recommendations.

Answer from: Medical Oncologist at Community Practice

Dual therapy will be over treatment.Agree with APT.

Answer from: Medical Oncologist at Academic Institution

Of the 406 women in the APT trial (Tolaney et al., PMID 25564897), 9 (2.2%) had T1mic disease and 6 (1.5%) had N1mic disease. These are very low numbers and it is unlikely that patient had both characteristics. Given the extremely low recurrence rates with the APT regimen (not dual anti-HER2 therapy...

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