Early Stage Her2-Positive Breast Cancer


Dr. Denise Yardley of the Sarah Cannon Research Institute discusses treatment options for women with early stage breast cancer that is Her2-positive.

Q: Welcome to Understanding Cancer.  Today we’re speaking with Dr. Denise Yardley, the director of the breast cancer research program at the Sarah Cannon Research Institute in Nashville, Tennessee.  Welcome.

A: Thank you.

Q: So patients have to make a decision about hormonal therapy, they have to make a decision about chemotherapy, they have to undergo genetic testing.

A: [Laughs.]

Q: And there’s a protein called HER-2/neu that has been in the news and discussed and has targeted therapies developed for it over the last several years.  What patients benefit from HER-2/neu therapies, and what therapies are available for early stage cancers?

A: For early stage cancer right now the current FDA approved drug is Herceptin.  That’s been approved both for advanced patients and now for the early stage patients.  And about 15 to 20% of patients are HER-2 positive, so for all of those patients, unless there’s some contraindication or a very, very small tumor, on the magnitude of a few millimeters, Herceptin is recommended.

Now, there are many clinical trials that are ongoing that we do encourage patients to consider evaluating new HER-2 targeted therapies, and one of the trials is a worldwide trial that’s looking at another new drug, Tykerb or Lapatinib, that’s right now FDA approved for advanced breast cancer patients.

It works a little differently in mechanism – it’s a pill versus Herceptin that’s injectable – to reduce the risk of HER-2 positive breast cancer coming back.  And so that’s now been moved into an early stage breast cancer trial worldwide, and we do encourage patients to consider participating in that trial.  It gives them an option of a drug that may at least be equivalent to Herceptin or have some superior benefits.

Q: So is it safe to say that Herceptin would be considered standard of care for HER-2 positive patients?

A: Yes.

Q: With node positive, but not necessarily node negative early stage disease?

A: It’s actually now there are four major early stage trials, and two of them allowed node negative patients.  They were a very small portion of those, but there’s not any reason to predict or think that a HER-2 node negative patient wouldn’t derive the same risk reduction.  We know some node negative breast cancers are equivalent in risk to a very low grade one lymph node positive breast cancer, so I think the benefits really are across the board in both node positive and node negative, and I would not restrict it to just a node positive group.

Q: So at this point you test all patients for HER-2/neu?

A: All patients.

Q: And anyone that’s positive you have a discussion about whether or not Herceptin would be beneficial—

A: Bene—

Q: Well, actually, you just said you recommend it.

A: I recommend it for all patients.

Q: Yeah, okay.  Well, Dr. Yardley, I’d like to thank you for your time today.  I think our viewers will find this session most informative, and we look forward to having you back.

A: Thank you.

[End of recording.]

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