Navigating Second-Line Choices in HER2+ Breast Cancer

This is a video synopsis/summary of a Peer Exchange involving Joyce O’Shaughnessy, MD; Priyanka Sharma, MD; Claudine Isaacs, MD; Heather McArthur, MD; and Hope S. Rugo, MD, FASCO.

Sharma discusses second-line treatment choices for HER2-positive breast cancer, emphasizing the key findings from the DESTINY-Breast03 trial. This trial established trastuzumab deruxtecan (T-DXd) as a superior option compared with trastuzumab emtansine (T-DM1), showcasing remarkable efficacy with a median progression-free survival (PFS) of 29 months and an overall survival benefit. Sharma highlights the clarity in choosing T-DXd as the preferred second-line option, except for patients with active brain metastases. For this subset, the tucatinib-based regimen might be more favorable, especially considering data from the HER2CLIMB trial that explored the tucatinib plus T-DM1 combination. The decision to select patients with active brain metastases for the tucatinib triplet regimen is based on the robustness of the data in this specific context. Sharma acknowledges the simplicity of the tucatinib regimen but leans toward T-DXd for its overall survival and PFS benefits. The discussion reflects the evolving landscape of treatment options for patients with HER2-positive breast cancer and the considerations for tailoring therapies to different patient subsets.

Video synopsis is AI-generated and reviewed by OncLive^® editorial staff.