Christine Sam, MD, assistant member, Department of Individualized Cancer Management/Senior Adult Oncology Program, Moffitt Cancer Center, discusses strategies for sequencing tucatinib (Tukysa) and fam-trastuzumab deruxtecan-nxki (Enhertu) in the treatment of patients with HER2-positive breast cancer.

Tucatinib and trastuzumab deruxtecan have made a significant impact on the treatment of this population, but questions remain regarding which patients will derive the most benefit from these therapies and how they should be sequenced, according to Sam. Currently, sequencing for the drugs is determined by toxicity, as well as patient and tumor characteristics, Sam says. 

Although these agents are currently being utilized mostly in the third-line setting or later, a big question moving forward will be whether they can be moved earlier on in the course of treatment, Sam explains. To this end, several ongoing trials are examining whether this is feasible and whether it could further improve outcomes for patients, Sam concludes.

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Christine Sam, MD, discusses strategies for sequencing tucatinib and fam-trastuzumab deruxtecan-nxki in the treatment of patients with HER2-positive breast cancer. 

Dr. Sam on Sequencing Tucatinib and Trastuzumab Deruxtecan in HER2+ Breast Cancer

Christine Sam, MD, assistant member, Department of Individualized Cancer Management/ Senior Adult Oncology Program, Moffitt Cancer Center, discusses therapeutic developmentsin metastatic HER2-positive breast cancer.

The treatment paradigm of HER2-positive breast cancer has grown considerably in recent years in both the early-stage and metastatic settings, Sam explains. In the metastatic setting, where there were significant unmet needs, tucatinib (Tukysa) and fam-trastuzumab deruxtecan-nxki (Enhertu) represent welcome additions to the armamentarium, Sam adds.

Notably, tucatinib has demonstrated activity in terms of progression-free survival and overall survival benefit in patients with central nervous system (CNS) metastases. Prior to the phase 2 HER2CLIMB trial (NCT02614794) with tucatinib, clinical trials typically excluded patients with CNS involvement, Sam concludes.

Christine Sam, MD, discusses therapeutic developments in metastatic HER2-positive breast cancer. 

Dr. Sam on Therapeutic Developments in Metastatic HER2+ Breast Cancer 

Christine Sam, MD, assistant member, Department of Individualized Cancer Management/Senior Adult Oncology Program, Moffitt Cancer Center, shares strategies to manage interstitial lung disease (ILD) experienced with fam-trastuzumab deruxtecan-nxki (Enhertu) in patients with HER2-positive breast cancer. 

ILD continues to be a risk for patients with HER2-positive breast cancer who have received treatment with this antibody-drug conjugate. Early recognition and staying vigilant about this adverse effect is key, according to Sam. Grade 1 ILD is considered to be asymptomatic, but if there is any concern like fibrosis or concern for ILD on imaging, then it must be worked up immediately, Sam says. There can be other causes for the appearance of ILD on imaging, but if it is determined to be because of the drug, then the treatment must be held, Sam explains.

If the effect proves to be asymptomatic, then the agent can be reintroduced upon resolution of the effect, Sam adds. If symptomatic, the treatment must be discontinued. Moreover, for any patient who has symptomatic ILD, early treatment is important. They should receive high-dose steroids, administered over a long taper, to ensure the resolution of symptoms, Sam concludes.

Christine Sam, MD, shares strategies to manage interstitial lung disease experienced with fam-trastuzumab deruxtecan-nxki in patients with HER2-positive breast cancer. 

Dr. Sam on Managing ILD With Trastuzumab Deruxtecan in HER2+ Breast Cancer 

Christine Sam, MD, hematologist and oncologist, assistant member, Department of Individualized Cancer Management/Senior Adult Oncology Program, Moffitt Cancer Center, discusses the importance of ​performing geriatric assessments during the coronavirus disease 2019 (COVID-19) pandemic​.

​Ensuring geriatric assessments are done can be challeng​ing in ​the clinic​al setting, says Sam. ​As such, having resources ​available to conduct this testing quickly and efficiently is of critical importance.

Common techniques include ​utilizing the CRASH (Chemotherapy Risk Assessment Scale for High-Age Patients) score, which stratifies patients into 4 risk categories for severe toxicity, as well as the CARG (Cancer Aging Research Group) score, both of which can be conducted online. 

Additionally, several ​physical assessments, such as the Timed Up and Go test, have been extremely beneficial ​in assessing older patients, especially during the COVID-19 pandemic, Sam concludes.

Christine Sam, MD, discusses the importance of ​performing geriatric assessments during the coronavirus disease 2019 pandemic​.

Dr. Sam on the Importance of Performing Geriatric Assessments During the COVID-19 Pandemic  

Christine Sam, MD, hematologist and oncologist, assistant member, Department of Individualized Cancer Management/Senior Adult Oncology Program, Moffitt Cancer Center, discusses strategies to mitigate the risk of the coronavirus disease 2019 (COVID-19) in elderly patients with cancer. 

Elderly patients with cancer are at an increased risk of contracting COVID-19, Sam says. 

As such, practicing social distancing, wearing masks, performing good hand hygiene, and avoiding touching their faces are potential strategies patients can use to mitigate this risk, explains Sam. Additionally, ensuring that patients are up to date on their vaccinations is critical to minimize the risk of pneumonia in this population.

Typically, older patients come to the clinic more often than younger patients, Sam says. 

Given the COVID-19 pandemic, improving telehealth options, increasing geriatric-friendly alternatives to telemedicine, and providing supplemental education or IT support can make elderly patients more comfortable with using telehealth options, concludes Sam. 

Christine Sam, MD, discusses strategies to mitigate the risk of the coronavirus disease 2019 in elderly patients with cancer.  



Christine Sam, MD

Articles

Dr. Sam on Sequencing Tucatinib and Trastuzumab Deruxtecan in HER2+ Breast Cancer

Dr. Sam on Therapeutic Developments in Metastatic HER2+ Breast Cancer

Dr. Sam on Managing ILD With Trastuzumab Deruxtecan in HER2+ Breast Cancer

Dr. Sam on the Importance of Performing Geriatric Assessments During the COVID-19 Pandemic

Dr. Sam on Mitigating Risk of COVID-19 in Elderly Patients With Cancer