Understanding Therapeutic Options for ER+/HER2- Metastatic Breast Cancer

Experts discuss treatment options for those with ER-positive, HER2-negative stage 4 breast cancer: © stock.adobe.com.

For patients navigating a diagnosis of estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer, understanding treatment options, such as hormone therapy, is crucial.

Hormone therapy, also known as endocrine therapy, works by blocking these hormones or reducing their levels in the body, thereby slowing or stopping cancer growth. Initial hormone therapy often involves a combination of medications, frequently including a CDK4/6 inhibitor paired with an aromatase inhibitor or fulvestrant.

These treatments aim to provide long-term control of the disease; however, cancer may become resistant to therapy over time. In this disease space, subsequent treatments often involve switching to a different type of hormone therapy, sometimes combined with other targeted drugs that address new genetic changes the cancer may have developed. Genomic testing, often through a liquid biopsy, plays a vital role in identifying these changes and guiding treatment decisions.

Following a CURE® Educated Patient® Updates event, Dr. Alicia Arnold and Dr. Priyanka Raval, both from Georgia Cancer Center, discussed key takeaways for patients to better understand their treatment options in advanced breast cancer.

As a provider, what questions do you wish your patients would ask you about their care?

Arnold: As a surgeon, I'm very much involved in all of my patients’ care. When it comes to surgery, (patients) sometimes don't truly understand what we're trying to accomplish with the surgery, (like)… getting a double mastectomy. People falsely think that that will cure you forever and you never, ever have to worry about breast cancer again. I think (patients) need to understand that with surgery, it's not 100% (curative).

We don't want you to worry about your breast cancer. We want you to live your life as if you don't have to worry about it. But, keep those appointments to continue to check yourself because (some people) falsely believe that mastectomies are curative forever.

Can you provide some key highlights that were discussed at the event?

Arnold: Overall, we had a really good turnout. (At the meeting, we covered) a lot of the basics, went over the different hormone receptors, and what that means; common treatments, medications and why they're used for those different receptors; as well as metastatic disease…

(In addition, Dr. Raval) went over what that all means and when to get genetic testing to see if you have an ESR1 mutation or deletion, and to see if (your disease becomes) resistant to therapies.

Can you discuss the treatment options available for ER-positive/HER2-negative metastatic breast cancer?

Raval: CDK4/6 inhibitors are the backbone now… (and we should give patients) basic information on aromatase inhibitors and tamoxifen, which is essentially bread and butter.

What are you hoping was the biggest takeaway for patients?

Arnold: When you hear stage 4, it sounds like it's like a death sentence, it’s terminal, and you have no hope. (The Educated Patient Updates event) really showed that there are a bunch of options. The biggest takeaway, which really excited me, was that this type of breast cancer will almost be like a chronic condition that's managed like diabetes…or high blood pressure that can be controlled over a long period of time… I felt that the patients really benefited from hearing that.

Raval: (I hope the biggest takeaway was) the power of knowledge to be able to ask the right kind of questions in clinic. If (the audience) retained even 40% of what we (discussed), if they took notes, then they could go back to their providers, or come back to us in clinic and be able to ask the right questions. … This may close those disparities or gaps in knowledge where the patient is not just talking about their own care, but they are looking at it from a wider lens, what research is happening, what has been the overarching treatment plan and how it's changed, and how exciting it is. It gives hope to some people as well.

For more news on cancer updates, research and education, don’t forget to subscribe to CURE®’s newsletters here.