Navigating Treatment Options for HER2+ BC: A Need for Customization

The DAPHNe trial (NCT03716180) investigated the prevalence and dynamics of circulating tumor DNA (ctDNA) in patients with early-stage HER2-positive breast cancer undergoing neoadjuvant therapy.

In the study, 92% of patients had detectable ctDNA at baseline, suggesting widespread minimal residual disease (MRD). Neoadjuvant therapy, primarily consisting of trastuzumab (Herceptin) and pertuzumab (Perjeta) was highly effective in clearing ctDNA, regardless of the initial tumor stage.

With a median follow-up of 50 months, no breast cancer recurrences have been observed in the study population. While the study did not find a strong direct correlation between ctDNA levels and residual cancer burden (RCB), the data suggest that ctDNA detection may be a valuable biomarker for monitoring disease progression and treatment response.

Overall, the DAPHNe trial provides evidence that ctDNA measurement can be a valuable tool in the management of HER2-positive breast cancer, particularly in the context of neoadjuvant therapy.

Here, Adrienne Waks, MD, senior physician and the associate director of breast oncology clinical research at Dana-Farber Cancer Institute and an assistant professor of medicine at Harvard Medical School, discusses the unmet needs in this patient population.

Transcription:

0:05 | We were looking at patients with early stage, stage II and stage III HER2-positive breast cancer. And I think in that space, the biggest unmet need at the moment is that we have this expanding set of options for how we treat them. We can give a lot of chemotherapy, we can give a lot of anti-HER2 drugs. We can give a little chemotherapy. We could give no chemotherapy and only anti-HER2 drugs. So, it's a good problem to have. In some ways, we have all these different options, but a big issue at the moment is we don't know how to customize them. We don't know how to figure out which patient needs the most that we can give them, which patient could get away with a lot less and obviously be spared unnecessary toxicity.

Transcript generated with AI and edited for clarity.