Neoadjuvant therapy is of great significance for the comprehensive treatment of HER2-positive breast cancer. With the updating and improvement of anti-HER2 treatment concepts, more and more HER2-targeted therapeutic drugs are approved and gradually move towards clinical application. How to better explore the treatment plans for HER2-positive breast cancer, optimize the neoadjuvant-adjuvant treatment mode, and improve the prognosis of HER2-positive breast cancer patients is also a question we need to consider. At the 18th St. Gallen International Breast Cancer Conference (SGBCC 2023), Oncology Frontier interviewed Dr. Giuseppe Curigliano of the University of Milan School of Medicine, Italy, asking him to share his experience and views.
Oncology Frontier : :Is there any prospect neoadjuvant systemic treatment de-escalation, especially chemotherapy de-escalation?
Dr. Giuseppe Curigliano: Yes, I believe it is worth considering discontinuing anthracycline drugs. The first step in downgrading treatment should be to increase TCHP treatment and stop anthracyclines, which will not decrease the patient’s pathological complete response (pCR) rate and can reduce the occurrence of related cardiac adverse events.
Oncology Frontier : Which breast cancer population may benefit from the intensive therapy of tyrosine kinase inhibitor (TKI) after 1 year of treatment?
Dr. Giuseppe Curigliano: This is a very important question. We must not forget the ExteNET study. This excellent trial indicates that after completing one year of trastuzumab neoadjuvant/adjuvant treatment, neratinib can benefit HER2-positive breast cancer patients. The limitation of this study on neratinib is that (neoadjuvant treatment was trastuzumab monotherapy), and (at the time of the study) trastuzumab combined with pertuzumab was not the standard neoadjuvant treatment plan, and the adjuvant treatment did not use T-DM1 (for non-pCR patients) as standard treatment.
Oncology Frontier : Is there any possibly valuable investigation of adjuvant trastuzumab emtansine (T-DM1) plus pertuzumab？
Dr. Giuseppe Curigliano: The KATHERINE trial was an example. I am not so sure that combining an ADC (herein referred to T-DM1) with pertuzumab can have a major role. Actually, we have one study in neo-adjuvant setting in which this strategy is explored in combination with pertuzumab. We have to wait the data, but if you consider that the mechanism of endocytosis, finally with down regulator to expression, how pertuzumab can potentially inhibits the dimerization. So this is an open question. And I believe that the trial with T-DM1 will give us their response.
Oncology Frontier : Will trastuzumab deruxtecan (DS-8201) challenge trastuzumab plus pertuzumab in early breast cancer treatment?
Dr. Giuseppe Curigliano: What is known so far is that at least in second-line treatment, the median progression-free survival of patients treated with trastuzumab deruxtecan (DS-8201) seems to be longer than that of the first-line treatment with trastuzumab + pertuzumab + paclitaxel. Therefore, DS-8201 is very likely to be superior to the combined treatment of trastuzumab + pertuzumab in the early stages.
Giuseppe Curigliano
Doctor of Medicine
Associate Professor of Oncology at the University of Milan School of Medicine, Italy
