Prognostication Remain Important in HER2-Positive Breast Cancer

Elisa Agostinetto, MD, of the Istituto Clinico Humanitas in Rozzano, Milan, Italy, discussed the rational of investigating the accuracy of PREDICT+ in HER2-positive breast cancer.

According to Agostinetto, there is the misbelief that prognostication in HER2-positive disease is not as important as other breast cancer subtypes. In HER2-negative disease, prognostication is used to determine if the patient will receive adjuvant chemotherapy or adjuvant endocrine therapy alone. In HER-positive breast cancer, almost all patients receive chemotherapy in the early setting.

However, prognostication in HER2-positive breast cancer remains important for other reasons. One is to help patients make certain life choices, especially around the planning of a reproductive life. Prognostication can help a patient determine if they choose to have a pregnancy or adopt. According to Agostinetto, this can help patients make decisions around the escalation and de-escalation of certain therapies. 

0:08 | The main rationale that led us to perform this study is really related to the fact that although one may think that prognostication in HER2-positive disease is not as important as in other breast cancer subtypes. For instance, in hormone receptor positive/HER2-negative breast cancer, prognostication is particularly important because you can really choose whether the patient would receive an adjuvant chemotherapy, or the adjuvant endocrine therapy alone. On the contrary, in HER2-positive breast cancer, almost the totality of patients in the early setting receive chemotherapy. The way of thinking is that prognostication can be less important in HER2-positive disease. On the contrary, as I said, I think that HER2-positive disease prognostication is very important. And one of the reasons is the one that I mentioned earlier, and it is really the planning of the reproductive life. Meaning that prognostication can really affect the choice for a young woman to have or not to have a pregnancy, for instance. But also, in terms of the choice of adopting, escalation and de-escalation treatment strategies, for instance. So, the idea was really to investigate the prognostic performance of PREDICT+, and the ALTTO trial was really the best study to test this because it has a very large population. And also, the follow up is very long.