Lowell L. Hart, MD, FACP, scientific director of clinical research at Florida Cancer Specialists & Research Institute, and associate professor of internal medicine at Wake Forest School of Medicine, discusses personalized treatment approaches for patients with HER2-positive breast cancer.

Patients with HER2-positive breast cancer should be re-biopsied at the time of their first recurrence, Hart explains. Drugs including fam-trastuzumab deruxtecan-nxki (Enhertu; DS-8201), trastuzumab (Herceptin), antibody-drug conjugates, and TKIs such as lapatinib (Tykerb), as well as investigational TKIs, such as tucatinib. have shown efficacy in this patient population. Tucatinib demonstrated promising activity at the 2019 San Antonio Breast Cancer Symposium.

However, there is still a challenge in treating patients with HER2-positive breast cancer who have brain metastases. While certain systemic therapies may not cross the blood—brain barrier, some of the newer agents in the pipeline, such as tucatinib, are able to better penetrate the brain, Hart concludes.

Videos

Lowell L. Hart, MD, discusses personalized treatment approaches for patients with HER2-positive breast cancer.

Dr. Hart on Personalized Treatment Approach for Patients With HER2+ Breast Cancer

Lowell L. Hart, MD, FACP, scientific director of Clinical Research at Florida Cancer Specialists & Research Institute, and associate professor of Internal Medicine at Wake Forest School of Medicine, discusses the impact of trilaciclib on myelosuppression in patients with previously treated extensive-stage small cell lung cancer. (SCLC).

Trilaciclib is a first-in-class intravenous CDK4/6 inhibitor that was designed to alleviate myelosuppression, a common adverse event associated with topotecan, in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets.

In this randomized phase II trial presented at the 2019 ASCO Annual Meeting, investigators evaluated the agent’s myelopreservation properties in patients with extensive-stage SCLC. Patients were randomized to receive either topotecan alone or topotecan and trilaciclib. When trilaciclib was used concurrently with chemotherapy, investigators observed a lower rate of neutropenia and improved tolerability. The agent has also enabled a longer duration of chemotherapy in patients with metastatic triplet-negative breast cancer.

Lowell L. Hart, MD, FACP, scientific director of Clinical Research at Florida Cancer Specialists & Research Institute, and associate professor of Internal Medicine at Wake Forest School of Medicine, discusses the impact of trilaciclib on myelosuppression in patients with previously treated extensive-stage small cell lung cancer.

Dr. Hart on Impact of Trilaciclib on Myelosuppression in Extensive-Stage SCLC

Lowell L. Hart, MD, scientific director of Research at Florida Cancer Specialists & Research Institute, and associate professor of Internal Medicine at Wake Forest School of Medicine, discusses the recent advances in the area of 

-positive non—small cell lung cancer (NSCLC).

The biggest advance, Hart explains, was in the last few years when crizotinib (Xalkori) was approved, as it is an agent with a specific molecular target that tremendously improves outcomes. Studies have shown that, compared with giving those patients chemotherapy, outcomes are improved when patients receive treatment with crizotinib versus standard therapy in first- or second-line settings.

Additional developments include ceritinib (Zykadia) and alectinib (Alecensa), which are both commercially available for patients. Both agents also have the ability to target brain metastases, which are common lesions in these patients. Patients with 

-positive NSCLC may develop brain metastases either at diagnosis or shortly after, Hart says.

Lowell L. Hart, MD, scientific director of Research at Florida Cancer Specialists & Research Institute, and associate professor of Internal Medicine at Wake Forest School of Medicine, discusses the recent advances in the area of ALK-positive non–small cell lung cancer.

Lowell L. Hart, MD

Articles

Dr. Hart on Personalized Treatment Approach for Patients With HER2+ Breast Cancer

Dr. Hart on Impact of Trilaciclib on Myelosuppression in Extensive-Stage SCLC

Dr. Hart on Advances in ALK+ NSCLC