Breast Cancer Clinical Case Review

Mridula George, MD, assistant professor of medicine at Rutgers Robert Wood Johnson Medical School, and associate program director for breast medical oncology program in the division of medical oncology at Rutgers Cancer Institute of New Jersey, presents the treatment options for this case of HER2-positive metastatic breast cancer.

Editor’s note: The following is an automatically generated transcript of the above video.

"So to discuss about treatment options, this is what the NCCN guidelines recommend. They recommend HER2 targeted therapy as a backbone, in addition with systemic therapy. The systemic therapy is usually chemotherapy. And in patients with ER-positive breast cancers, endocrine therapy is also encouraged.

So the first-line treatment option for patients diagnosed with metastatic HER2-positive breast cancer is a dual HER2 blockade with trastuzumab and pertuzumab, in combination with a taxane. Could be docetaxel or paclitaxel. So trastuzumab binds to domain IV of the extracellular domain of HER2, and it triggers a tumor-suppressive action through multiple mechanism, including activation of antibody-dependent, cell-mediated cytotoxicity, inhibition of the HER2 extracellular domain, and disruption of the HER2 homodimerization and heterodimerization. Pertuzumab is a recombinant humanized monoclonal antibody, but binds to a different HER2 domain than trastuzumab, and has been shown to work synergistically with trastuzumab."