Optimal Treatment Sequencing in Metastatic HER2+ Breast Cancer

Kathy D. Miller, MD


December 07, 2020

Dr Kathy Miller from Indiana University discusses treatment sequencing, clinical trials, and new third-line options for patients with metastatic HER2-positive breast cancer.

For patients with metastatic breast cancer who have an overexpression of HER2-neu, HER2-targeted therapy is a standard component of treatment.

In patients with locally unresectable disease without distant metastasis, cure remains the goal. Chemotherapy and dual HER2-targeted treatment is recommended first-line. In many patients, the tumor will become resectable, and they should seek surgery. Patients without a complete pathologic response should move to trastuzumab emtansine in the second-line setting.

Third-line therapy offers patients two powerful options: tucatinib or fam-trastuzumab deruxtecan. The HER2CLIMB trial showed higher rates of response, progression-free survival, and overall survival with tucatinib than with trastuzumab and capecitabine.

The DESTINY trial showed the antibody-drug conjugate fam-trastuzumab deruxtecan had an objective response rate of 80% and 12-month progression-free survival in a heavily pretreated patient population.

Dr Kathy Miller is encouraged by the number of efficacious options available in this patient population.


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