Komal Jhaveri, MD, FACP, a medical oncologist at Memorial Sloan Kettering Cancer Center, discusses sequencing treatments for patients with metastatic HER2-positive breast cancer.

When a patient begins frontline treatment, Jhaveri recommends the use of trastuzumab (Herceptin), pertuzumab (Perjeta), and chemotherapy. Moreover, ado-trastuzumab emtansine (Kadcyla) can be used in the second-line setting, based on the results of the EMILIA trial, which showed a benefit over lapatinib (Tykerb) plus capecitabine, Jhaveria says. 

There are 3 drugs currently available that have been approved by the FDA to treat patients in the third-line setting, including fam-trastuzumab deruxtecan-nxki (Enhertu), tucatinib (Tukysa) with capecitabine and trastuzumab, and neratinib (Nerlynx) plus capecitabine.

The treatment landscape has become crowded in light of these approvals, although Jhaveri emphasizes that this is a good problem to have. Due to this, it's important for physicians to consider characteristics of each individual patients to make optimal treatment decisions; toxicity profiles should also be taken into consideration, Jhaveri concludes.

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Dr. Jhaveri on Sequencing Treatments in Metastatic HER2+ Breast Cancer

Ruta D. Rao, MD, associate professor in the Department of Medicine, Division of Hematology at Rush Medical College, as well as the director of the Coleman Foundation Comprehensive Breast Cancer Clinic and medical director of Rush University Cancer Center, discusses emerging treatments for patients with HER2-positive metastatic breast cancer.

The breast cancer arena has seen a number of exciting developments in 2020, especially in the treatment of patients with HER2-positive disease, which saw 3 new FDA approvals, says Rao. The triplet of tucatinib (Tukysa), capecitabine (Xeloda), and trastuzumab (Herceptin) from the HER2CLIMB study has yielded exciting results due to the study's inclusion of patients with brain metastases, which has been an ongoing unmet need within this patient population, Rao says.

The antibody-drug conjugate fam-trastuzumab deruxtecan-nxki (Enhertu) was another agent that was approved by the FDA for pretreated patients with HER2-positive breast cancer. Additionally, the approval of neratinib (Nerlynx) in the metastatic setting has caused excitement, Rao concluded.

Ruta D. Rao, MD, associate professor in the Department of Medicine, Division of Hematology at Rush Medical College, as well as the director of the Coleman Foundation Comprehensive Breast Cancer Clinic and medical director of Rush University Cancer Center, discusses emerging treatments for patients with HER2-positive metastatic breast cancer.


SABCS 2020: Reflections in HER2+ Breast Cancer | Supplements and Featured Publications

Dr. Jhaveri on Sequencing Treatments in Metastatic HER2+ Breast Cancer

Dr. Rao on Emerging Treatments in HER2+ Metastatic Breast Cancer