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HER2+ Early Breast Cancer Roundtable: Discussing Treatment Options With Patients

This video highlights approaches to discussing various treatment options available for patients with HER2+ early breast cancer, including intravenous vs subcutaneous therapy, patient preferences such as freedom from the burden of a port-a-cath or fear of needles for intravenous therapy, as well as benefits associated with faster treatment options. 

For more HER2+ early-stage breast cancer content, visit the Resource Center.

This video is sponsored by Phesgo.


Dr Maryam Lustberg: It's wonderful that our patients with HER2+ breast cancer have the option for these lifesaving HER2-targeted therapies. We would like to highlight different approaches in terms of administration of these HER2-targeted therapies and how we can involve patients in the decision-making about certain conveniences about how these HER2-directed therapies are administered.

So, just kind of wanted to chat with all of you in terms of, we've talked about at least a year of treatment in HER2+ breast cancer that although patients have excellent outcomes, it can still be quite a burden to have long infusion visits, and certainly the burden of a port-a-cath can mean differently to different patients, and obviously, time in the infusion chair can also, during busy lives, can be burdensome for patients and also can be a drain of time in the health care facility for nurses and pharmacists. So just wanted to kind of hear perspectives in terms of how you're managing these discussions with your patients, how are you presenting options for intravenous versus subcutaneous HER2-directed therapy? Curious to hear your thoughts.

Dr Ting Bao: I just want to say in our institution it's actually not necessarily recommended to start with a mediport. So, often patients just come in every few weeks to get a peripheral IV unless the chemo nurse tells us, "You have to." Then we do it. Therefore, the percentage actually quite low. So, as a result, some patients would come every few weeks to get that and for the HP treatment, sometimes the IV became very troublesome, so they would request, "Do you have something else?" Then we have this great option of subcutaneous treatment then we would offer to the patient. I do have some, especially elderly patients, really like this option.

Dr Giancarlo Moscol: It has been very convenient. I have used it both in the adjuvant setting as well in the metastatic setting. They love the fact that you're only like 5 minutes in and out. You don't even need to check bloodwork. I mean, with HERCEPTIN and PERJETA, we hardly ever, maybe every, I don't know, 4 to 6 cycles. Reasonably well-tolerated and potentially minimal reactions just in the skin and that's it. So, very good experience overall. Sometimes we just recommend a surgeon to proceed and remove the port after they have completed their neoadjuvant treatment and then switch to treatments later.

Dr William Gradishar: I think it's some patients, quite frankly, they like coming in and not so much getting stuck with a needle, but they're not necessarily opposed to the idea of a longer visit. But that said, when you have the subcutaneous option that's been demonstrated in clinical trials to be equally effective, no difference in toxicity, and the big difference is time, which they save a significant amount of, that's appealing to many patients. So, I think that we try to make them aware that that is an option and then they decide.

Dr Maryam Lustberg: Right. I think we just really wanted to highlight that point, that I know it's very important for patients to know that they're aware of all their choices, and I think sometimes it's driven by insurance consideration but generally I think both approaches are covered, and it's really nice to be able to give them a choice when so many choices have been taken away as a result of the cancer diagnosis. What about experiences in your infusion facility with the subcutaneous formulation in terms of, have you received any feedback from pharmacists or nurses in terms of how it's going?

Dr Giancarlo Moscol: So usually, those patients will go on the fast-track pod. So, we have a different area, a little more convenient. We are, I don't know if the same is happening at your center, but we're having a problem with a shortage of staffing for nursing.

Dr Maryam Lustberg: Yes.

Dr Giancarlo Moscol: So, it's been quite challenging-

Dr Maryam Lustberg: Yes.

Dr Giancarlo Moscol: I think that having a shorter administration be as subcutaneous can also be convenient because you don't need to have the patient tied up to a chair for many hours. It has become very challenging when I get to see a new patient, and we have to discuss the expected initiation treatment and the delays.

Dr Maryam Lustberg: Yes. No same, similar problems. Definitely. A massive health care and nurse shortage for sure. Yes. It really helps with that for sure. Any other thoughts?

Dr Ting Bao: Occasionally, I would put in the order and then get the feedback saying insurance didn't approve, then I have to switch back. Very rarely though.

Dr Maryam Lustberg: Yes, I think I've had good feedback from patients, and as you mentioned, really strong similar efficacy data so that we can feel confident recommending this as an option.