While endocrine therapy has been used for hormone-receptor(+) breast cancers for half a century, it took a while longer for HER2(+) breast cancer to establish itself as a unique entity worthy of unique treatments. Its voice has now been heard such that today HER2-targeted therapies are giving cytotoxic chemo a run for its money. The recently reported ALTERNATIVE trial assessed various targeted-therapy combos for hormone-receptor(+), HER2(+) metastatic breast cancers previously treated with chemo and endocrine therapies. The answer for triple-positive cancers, it seems, is triple the blockade. The winning regimen at prolonging progression-free survival was aromatase inhibitor (AI) + trastuzumab + lapatinib as opposed to combos of AI + a single HER2-targeted therapy. More importantly, #HERtoo metastatic disease can finally join the ranks of breast cancers with effective chemo-free treatment options--a righted injustice that would make even Oprah proud.


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