Dr. Bachelot on the Role of Tucatinib in HER2+ Breast Cancer With CNS Metastases

Thomas Bachelot, MD, PhD, a medical oncologist at Centre Leon Berard, discusses the role of the combination of tucatinib (Tukysa) plus trastuzumab and capecitabine in patients with HER2-positive breast cancer who have central nervous system (CNS) metastases.

In April 2020, the FDA approved the tucatinib triplet for the treatment of patients with unresectable locally advanced or metastatic HER2-positive breast cancer, including those with brain metastases, following at least 1 previous anti–HER2-based regimen in the metastatic setting based on data from the phase 2 HER2CLIMB trial (NCT02614794). The regimen was subsequently approved by the European Commission in February 2021 for those who previously received at least 2 HER2-targeted regimens. The impact of the combination on the paradigm is significant because of the survival benefit it has demonstrated, Bachelot says.

During the ESMO Breast Cancer Virtual Congress 2021, the combination was well reviewed, Bachelot notes. Currently, in Europe, the first-line treatment strategy in this patient population consists of trastuzumab (Herceptin) plus pertuzumab (Perjeta), while ado-trastuzumab emtansine (T-DM1; Kadcyla) is used in the second line. Now, the tucatinib triplet can be utilized in the third-line setting. The regimen has demonstrated a clear improvement in overall survival, and its approval in Europe is an important development in patient care as it provides yet another treatment option, Bachelot concludes.