We have two trials out there looking at anti-HER2 therapy plus/minus endocrine therapy in the setting. One trial is the ADAPT Trial looking at hormone receptor-positive, HER2-positive disease at 12 weeks of T-DM1 (ado-trastuzumab) plus/minus endocrine therapy, where there was no difference in the pCR (pathologic complete response) rate but a substantial pCR of 41% with 12 weeks of TDM1 alone.
The second trial is the NSABP B-52 trial, a phase III trial that looked at TCHP (docetaxel, carboplatin, trastuzumab, and pertuzumab) plus/minus endocrine therapy.
Both trials involved pre- and postmenopausal patients. And again, the NSABP B-52 trial did not show an improvement of the pCR in hormone receptor-positive HER2-positive disease by adding endocrine therapy to anti-HER2 therapy.
What does that mean for clinical practice?
It means, first of all, the endocrine therapy did not negatively impact the pCR rate. So it’s safe to use endocrine therapy plus anti-HER2 therapy in the postoperative setting, but there is no need, so far, to combine it with the anti-HER2 therapy with a chemotherapy backbone in the neoadjuvant setting. We don’t know why that is; it may be that the times used in the studies were not long enough and endocrine therapy added to anti-HER2 therapy needs a longer time. But I think for the time being, we should not combine endocrine therapy plus chemotherapy and anti-HER2 therapy in the neoadjuvant setting.
My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida.
I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016.
Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida.
Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.
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