Advancing Breast Cancer Care With HER2-Targeted Therapies

At our recent Institute for Value-Based Medicine® event in Boston, the theme of the evening’s presentations was “Elevating Value in Cancer Care,” with 4 disease states and clinical areas serving as case studies for this outcome: non–small cell lung cancer, breast cancer, sarcomas, and pharmacy. Michael Hassett, MD, MPH, was a discussant during the panel, “Precision Medicine: Targeting HER2 in Cancer,” and in this clip from our interview, he hits on 2 important topics in breast cancer that most often overlap: targeted therapy innovation and how to besti identify patients who could benefit.

Hassett is a medical oncologist at Dana-Farber Cancer Institute in Boston, where he sees patients in the breast cancer clinic and serves as its chief quality officer, charged with identifying care quality gaps and reducing care disparities.

This transcript has been lightly edited.

Transcript

Given the increasing focus on value-based care, what are some of the most promising strategies for improving outcomes and reducing costs in the cancer care landscape?

There's really been a transformation in cancer care over the last 10 to 20 years. I think top of the list for me is targeted therapy, being able to identify biomarkers in cancer and then to provide specific treatments that work in those patients without having to treat patients who don't need those treatments.

There are other things, of course, that we can do to support value in cancer care that include everything from more support of the patient through care management, symptom management, and the use of pathway programs that help us ensure that we're providing the right treatments to the right patient at the right time.

What are the most significant findings from your presentation, "Precision Medicine: Targeting HER2 in Cancer”?

There are, for me, 3 main takeaways during the session, and they all revolve around targeted therapy for breast cancer. HER2 is a key target in breast cancer treatment. There's been many innovations over the last 20 years in the treatment of HER2-positive cancer. We know that these medicines work. We know that they work very, very well. There are still a lot of questions, though, top among them, which patients need which treatments. The traditional biomarkers that we used to identify who gets treated with her HER2-targeted therapy is really changing. We used to always look at immunohistochemistry as a target. Now we have totally new concepts, like HER2-low and HER2-ultra-low that are going to transform the way we use these treatments.

I think second on the list is the use of targeted treatments in ER-positive breast cancer. ER, the estrogen receptor, is one of the first targets in breast cancer. It's been around for over 40 years as a [target] which guides therapy for these patients. Now we're using targeted treatments like CDK inhibitors, which are really transforming the outcomes in these patients. These are expensive medications, so we have to be really clear about which patients really need them and benefit from them, and we'll need better targets to identify who really benefits from these.

I think the third one is that we're transforming the way that we provide cancer care with targeted treatments. We have more and more tailored treatments for the given population of patients, and the notion that we can always know the exact right treatment at the right time is going to become increasingly hard. Tools like decision support and education events, including events like today's, I think are going to be critical for making sure that we're giving the right patients the right treatments at the right time.