Dr. Meisel on Sequencing Therapies in Metastatic HER2+ Breast Cancer

Jane L. Meisel, MD, an associate professor in the Departments of Hematology and Medical Oncology and Gynecology & Obstetrics at Winship Cancer Institute, Emory University School of Medicine, discusses sequencing therapies for patients with metastatic HER2-positive breast cancer.

An optimal strategy for sequencing is not completely standardized, as there are a number of options in the space to help meet the needs of each patient, Meisel says. However, it is clear that a taxane plus trastuzumab (Herceptin)/pertuzumab (Perjeta) is a go-to first-line option, she explains.

For the majority of patients, ado-trastuzumab emtansine (T-DM1; Kadcyla) is still a second-line option, with the exception of patients who recur with significant brain disease and less systemic disease, Meisel says. Additionally, there is the option to utilize a combination of tucatinib (Tukysa), trastuzumab, and capecitabine prior to T-DM1 in this population due to the impressive brain metastases data yielded from the phase 2 HER2CLIMB study (NCT02614794). The April 2020 FDA approval of this combination was in the second-line setting or later for patients with metastatic HER2-positive breast cancer despite the study focusing on the third- or later-line setting

However, the majority of patients in the second-line setting would receive T-DM1 or be enrolled on a clinical trial. At the Winship Cancer Institute, a trial is currently ongoing that examines T-DM1 with or without tucatinib, which could be a promising option for patients with brain metastases, Meisel concludes.