Questions and Experts Session Guide: A Medical Oncologist Answers Questions about HER2-Positive Breast Cancer

A breast cancer diagnosis comes with so many questions and there never seems to be enough time at appointments to have some of these questions answered. To help address this, we developed a "Q&E: Questions and Experts" series. In this series, a variety of experts spend the entire virtual session answering pre-submitted and live questions from participants. Watching the videos on-demand might be a little difficult to get through. So, we’ve created this guide to help you get right to the questions and answers that matter the most to you.

In today’s post, we provide the questions that were sent in and asked during the live session of our Questions and Experts session held in April 2021. In this session, Dr. Karen Gelmon, MD, FRCPC, a Medical Oncologist, answered questions about HER2-positive breast cancer. In the parentheses, you’ll find the timestamp of where to find the question in the on-demand video.

COVID-19: Vaccines, Clinical Trials, and the Impact on Cancer Treatment

1. Some people are now getting their treatments every four weeks, instead of three, is this something that is available to everyone, if not what is the criteria to have this? (3:32) 
2. This pandemic has shown a different way of treating patients. Will strategies change or has this always been the case in terms of always having treatments every three weeks instead of four weeks? (7:30) 
3. In speaking about the timeframe of how cancer treatments have changed due to the pandemic, you’d mentioned Perjeta and Herceptin, what about TDM1 (Kadcyla)? (10:33) 
4. I’ve been reading about the mRNA platform and precision medicine for some years now. Are researchers, pharmaceutical companies, and everyone else going to do a little more work around that type of treatment following the COVID-19 vaccine? (15:28)
5. Because of the way the pandemic accelerated the phases in clinical trials for the use of the COVID-19 vaccine, do you think that the same thing will happen for cancer clinical trials, with trial phases becoming more accelerated?  (40:47) 

Breast Cancer Drugs

1. In speaking about the timeframe of how cancer treatments have changed due to the pandemic, you’d mentioned Perjeta and Herceptin, what about TDM1 (Kadcyla)? (10:33) 
2. Perjeta is known to work on the HER3 and HER2 pathway, and often, brain metastases are involved with the HER3 pathway. Is there any evidence that Perjeta is crossing the blood-brain barrier (BBB) after stereotactic radiosurgery to keep the brain stable from further brain metastases? At what point is it safe to consider discontinuing Perjeta due to neuropathy side effects? (35:04) 
3. In terms of the yearlong Herceptin regime, do you think there will ever be or is there any consideration of modifying it to have a lesser time of receiving the treatment with the same effectiveness? (32:35) 
4. What other treatments are being used or can be recommended to use for metastatic HER2-positive breast cancer for third line treatment, after TDM1? (38:08) 
5. Can Herceptin, or some variant thereof, be used as a prophylactic (44:53) 
6. In the metastatic space, if someone has no evidence of disease for years, are they considered cured or will they always have to stay in treatment? (1:18:52) 
7. What is the long-term stability for someone receiving Herceptin for HER2-positive metastatic breast cancer? (1:21:10) 
8. Would someone receiving the biosimilar Ogiviri for trastuzumab, instead of Herceptin, expect the same outcome as she would with the reference biologic? (1:22:40) 

Research and Clinical Trials

1. There is talk of a future vaccine to prevent cancer from growing, are you able to comment or provide insight into any of this research? (12:42) 
2. I’ve been reading about the mRNA platform and precision medicine for some years now. Are researchers, pharmaceutical companies, and everyone else going to do a little more work around that type of treatment following the COVID-19 vaccine? (15:28)
3. Because of the way the pandemic accelerated the phases in clinical trials for the use of the COVID-19 vaccine, do you think that the same thing will happen for cancer clinical trials, with trial phases becoming more accelerated?  (40:47) 
4. Touching on research looking into the environmental and lifestyle risk factors for breast cancer, do you think that we are continuing to do good work in that? Do you think there is any success in that? (46:11)
5. Does Vitamin D and Aspirin help reduce the risk of recurrence and has that been proven? (1:25:58) 
6. Where is the study on Aspirin and recurrence at this point, what is expected to be gained from it, and what would the side effects with Aspirin be? (1:27:39)

Risk of Recurrence

1. Are there other types of cancers that HER2-positive breast cancers survivors are more likely to get in the future? How do we test for those and are there symptoms that patients should be watching for? (16:52) 
2. What are the best treatment plans for high-risk HER2-positive breast cancer? Are CDK4/6 inhibitors plus anti-hormonal drugs something that should or could be used for non-metastatic cases to reduce risk of recurrence? (20:23) 
3. If someone is diagnosed with early-stage breast cancer, what is the likelihood that it will appear in the other breast within 5 years? Does the stage of breast cancer make a difference in recurrence? (1:07:51) 
4. Is there additional testing in follow-up care, other than just going back to have a mammogram done, to determine whether or not the cancer has returned? (1:13:34)
5. In terms of additional tests for risk of recurrence, what is your thought on adding patients’ tumor markers, for example CA125, to their standard blood work? (1:17:02) 
6. Does Vitamin D and Aspirin help reduce the risk of recurrence and has that been proven? (1:25:58) 
7. Where is the study on Aspirin and recurrence at this point, what is expected to be gained from it, and what would the side effects with Aspirin be? (1:27:39)

Treatments and Treatment Decision-Making

1. What are the best treatment plans for high-risk HER2-positive breast cancer? Are CDK4/6 inhibitors plus anti-hormonal drugs something that should or could be used for non-metastatic cases to reduce risk of recurrence? (20:23) 
2. Is there decision-making around treatments for HER2-positive with the age of the patient in mind? (24:03) 
3. How do you assess whether or not you are going to benefit from certain treatments? How does the medical oncologist asses who is high-risk and who might benefit from additional therapy? And how do patients consider that in their treatment decision-making?(26:53) 
4. Could you explain PARP inhibitors and why or when a PARP inhibitor agent would be used? (42:47) 
5. In terms of Oncotype DX testing, who is being tested? In what setting is this test being funded for patients? And how much of this is guiding treatment decisions? (1:01:21) 
6. Are HER2-positive cancers more resistant to endocrine therapy? How does endocrine therapy relate to triple positive breast cancers? (1:23:34) 

Metastatic Breast Cancer

1. Perjeta is known to work on the HER3 and HER2 pathway, and often, brain metastases are involved with the HER3 pathway. Is there any evidence that Perjeta is crossing the blood-brain barrier (BBB) after stereotactic radiosurgery to keep the brain stable from further brain metastases? At what point is it safe to consider discontinuing Perjeta due to neuropathy side effects? (35:04) 
2. What other treatments are being used or can be recommended to use for metastatic HER2-positive breast cancer for third line treatment, after TDM1? (38:08) 
3. In the metastatic space, if someone has no evidence of disease for years, are they considered cured or will they always have to stay in treatment? (1:18:52) 
4. What is the long-term stability for someone receiving Herceptin for HER2-positive metastatic breast cancer? (1:21:10) 

Prevention and Risk Factors: Familial, Environmental and Lifestyle

1. Can Herceptin, or some variant thereof, be used as a prophylactic? (44:53) 
2. Touching on research looking into the environmental and lifestyle risk factors for breast cancer, do you think that we are continuing to do good work in that? Do you think there is any success in that? (46:11)
3. Could you address some of the familial risks of breast cancer? And what can be done for women’s daughters who may be at an increased risk? (49:39) 
4. Is there a relationship between inflammation in the body and cancer? Can drugs such as Rapamycin and Metformin be used as a cancer preventive? (53:37) 
5. Is there any correlation between diabetes and a higher risk of breast cancer? (56:07) 
6. In speaking of lifestyle and environmental risk factors, is weight something that is addressed by an oncologist? (58:57) 

Testing

1. Are there any particular tests that can or should be done with the removal of various breast lumps? (49:39) 
2. In terms of Oncotype DX testing, who is being tested? In what setting is this test being funded for patients, and how much of this is guiding treatment decisions? (1:01:21) 
3. What are your thoughts on having other types of tests done on patients who the Oncotype DX testing may not be beneficial for? (1:05:19) 
4. In terms of additional tests for risk of recurrence, what is your thought on adding patients’ tumor markers, for example CA125, to their standard blood work? (1:17:02) 

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