Dr. Hamilton on the Complex Treatment Algorithm for HER2+ Breast Cancer

Erika P. Hamilton, MD, director of the Breast Cancer and Gynecologic Cancer Research Program and principal investigator at the Sarah Cannon Research Institute, discusses how she navigates the complex treatment algorithm for her patients with HER2-positive breast cancer.

The current treatment algorithm for patients with HER2-positive breast cancer is complex, according to Hamilton, who added that there is not a perfect option in the third-line space and that the decision should be based on each patient. If a patient has brain metastases, tucatinib (Tukysa) is approved for use in the second-line setting and beyond; as such, it is a reasonable option for this patient population, irrespective of whether the patient is receiving their second or third line of treatment, explains Hamilton.

In the absence of brain metastases, a few other factors can be taken into consideration. When treating a patient with lung disease, it might be better to avoid fam-trastuzumab deruxtecan-nxki (Enhertu), adds Hamilton. However, if a patient is in visceral crisis or if they need to elicit an immediate response, trastuzumab deruxtecan could represent a favorable option because the overall response rate associated with the agent is impressive, according to Hamilton. If a patient does not have an incredibly high burden of disease and they are doing well on treatment, a tucatinib regimen can potentially be used, notes Hamilton.

Treatment is not a one-size-fits-all answer; it is going to take more of a conversation with the patient and evaluation of the subtle differences in their disease presentation to optimally decide between the agents available, concludes Hamilton.