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If you’re diagnosed with stage four metastatic breast cancer that is HER2 positive, this used to be something that was very aggressive and was very scary when we found out that you had a positivity. However, we now have had several agents that we’ve found directly attack the cancer cells because of the presence of that receptor. And that has completely flipped the management and how people do and have good quality of lives when we can direct that receptor. In a metastatic stage four setting with HER2 positivity, there’s no right answer for initial therapy, because of the number of options you have. Again, it’s very important to determine, do you have a high burden critical disease where you would use combination chemotherapy plus therapy that attacks that HER2 receptor to reduce that critical disease, because you don’t have time to make sure you have a good response.
However, if you have limited disease, meaning the pain isn’t debilitating, no organ is threatened for future failure at any point soon, then you can mobilize all of these other options, but they will always involve targeted therapy for that HER2 receptor. It can be accomplished, say, if you’re hormone positive, by blocking your hormone, as well as attacking that receptor by what we call trastuzumab or pertuzumab. You can use a combination of those two drugs, and also you can use one with several other single agent chemotherapies to keep a good control of the disease while maintaining a good quality of life.
