Dr. Basho on the Evolution of Therapeutic Sequencing in HER2+ Breast Cancer

Reva K. Basho, MD, assistant professor of medicine, co-director, Women’s Cancer Program, Samuel Oschin Cancer Center, Cedars-Sinai Medical Center, discusses the evolution of therapeutic sequencing in HER2-positive breast cancer.

Based on findings from the phase 3 CLEOPATRA trial (NCT00567190), the combination of docetaxel, trastuzumab (Herceptin), and pertuzumab (Perjeta) has remained the frontline standard of care for patients with HER2-positive breast cancer, Bashoexplains. In the second-line setting, ado-trastuzumab emtansine (T-DM1; Kadcyla) was the standard of care option, Basho adds. Beyond this, physicians were left with the choice of how to treat patients that typically included chemotherapy in combination with HER2-directed therapy, Basho adds.

Novel FDA-approved agents have expanded the paradigm of HER2-positive breast cancer treatment, Basho says. For example, fam-trastuzumab deruxtecan-nxki (Enhertu) and tucatinib (Tukysa) have become established regimens in the third- and fourth-line settings for this patient population, Basho explains. Additional agents are emerging for use in HER2-positive breast cancer that could further shift sequencing, Basho concludes.