Mei Wei, MD, an internal medicine specialist at the University of Utah Health, discusses the potential clinical implications of the ongoing, phase 3 CompassHER2 RD trial (NCT04457596) in HER2-positive breast cancer.

The CompassHER2 RD trial is evaluating the combination of ado-trastuzumab emtansine (T-DM1; Kadcyla) and tucatinib (Tukysa) vs T-DM1 alone in patients with high-risk HER2-positive breast cancer who progressed on neoadjuvant chemotherapy regimens, such as docetaxel/trastuzumab (Herceptin)/pertuzumab (Perjeta), explains Wei.

Although the integration of T-DM1/tucatinib to the second-line setting could be beneficial for patients, utilizing a doublet early in the course of treatment may not be optimal, says Wei. It may be more feasible to utilize tucatinib alone in the second-line setting and reserve T-DM1 for the third-line setting, Wei adds.

As such, findings from the CompassHER2 RD trial must show significant clinical benefit with the combination vs T-DM1 alone without substantial toxicity to be considered in the second-line setting for this patient population, Wei concludes.

Videos

Mei Wei, MD, discusses the potential clinical implications of the ongoing, phase 3 CompassHER2 RD trial in HER2-positive breast cancer.  



Dr. Wei on the Potential Implications of the CompassHER2 RD Trial in HER2+ Breast Cancer 

Mei Wei, MD, an internal medicine specialist at the University of Utah Health, discusses the risk of interstitial lung disease (ILD) with fam-trastuzumab deruxtecan-nxki (Enhertu) in HER2-positive breast cancer.

Without effective intervention strategies to manage ILD, the toxicity could limit the utility of trastuzumab deruxtecan in patients with HER2-positive breast cancer, says Wei. Moreover, some patients develop ILD from prior ado-trastuzumab emtansine (T-DM1; Kadcyla), which renders them ineligible for trastuzumab deruxtecan, Wei adds. Although the guidelines on managing ILD in this patient population are not clear, patients who develop treatment-related ILD should discontinue trastuzumab deruxtecan, explains Wei.

Moreover, ILD could limit the utility of trastuzumab deruxtecan in the neoadjuvant or adjuvant settings where the goal of treatment is cure, Wei says. If patients are at risk of dying from ILD and other effective options that are better tolerated are available, it is unlikely that trastuzumab deruxtecan will be widely adopted in the localized setting, concludes Wei. 

Mei Wei, MD, discusses the risk of interstitial lung disease with fam-trastuzumab deruxtecan-nxki in HER2-positive breast cancer.  



Dr. Wei on the Risk of ILD With Trastuzumab Deruxtecan in HER2+ Breast Cancer 

Mei Wei, MD, an internal medicine specialist at the University of Utah Health, discusses the benefits of subcutaneous administration of pertuzumab (Phesgo) and trastuzumab (Herceptin) in patients with HER2-positive early breast cancer.

The concept of moving from administering these agents through a transfusion to delivering them subcutaneously is appealing, according to Wei. A transfusion of pertuzumab and trastuzumab and other chemotherapy infusions can exhaust patients and require them to stay in the hospital. Therefore, a subcutaneous delivery method may be more favorable for the patient and the hospital, Wei says.

Additionally, the transfusion of pertuzumab can induce adverse reactions and cause further stress for patients, physicians, and nursing staff, Wei adds. A subcutaneous strategy is more convenient for patients, can save time, and help to avoid adverse reactions, Wei concludes.

Mei Wei, MD, discusses the benefits of subcutaneous administration of pertuzumab and trastuzumab in patients with HER2-positive early breast cancer.

Dr. Wei on Benefits of Subcutaneous Pertuzumab/Trastuzumab in HER2+ Early Breast Cancer

Mei Wei, MD, an internal medicine specialist at University of Utah Health, discusses the efficacy of fam-trastuzumab deruxtecan-nxki (Enhertu) in HER2-positive breast cancer, as demonstrated in the phase 2 DESTINY-Breast01 trial (NCT03248492).

A significant progression-free survival benefit was observed with the antibody-drug conjugate in the heavily pretreated patient population, Wei says. Additionally, the agent showed promise in patients who with brain metastases, Wei notes.

Importantly, in patients who had received previous treatment for their brain metastases, the median overall survival had not yet been reached, Wei concludes.

Mei Wei, MD, discusses the efficacy of fam-trastuzumab deruxtecan-nxki in HER2-positive breast cancer, as demonstrated in the DESTINY-Breast01 trial.

Mei Wei, MD

Articles

Dr. Wei on the Potential Implications of the CompassHER2 RD Trial in HER2+ Breast Cancer

Dr. Wei on the Risk of ILD With Trastuzumab Deruxtecan in HER2+ Breast Cancer

Dr. Wei on Benefits of Subcutaneous Pertuzumab/Trastuzumab in HER2+ Early Breast Cancer

Dr. Wei on the Efficacy of Trastuzumab Deruxtecan in HER2+ Metastatic Breast Cancer