Dr. Rimawi on Treatment of Metastatic HER2+ Breast Cancer

Mothaffar F. Rimawi, MD, associate professor and director of clinical research at the Lester and Sue Smith Breast Center at Baylor College of Medicine, discusses the current treatment paradigm for patients with metastatic HER2-positive breast cancer.

Patients develop metastases because they become resistant to earlier lines of treatment, Rimawi says. The landscape of metastatic HER2-positive disease continues to evolve. Looking at primary breast cancer and metastatic disease, variations in mutational profile can be seen, suggesting that pathways become upregulated and develop resistance to therapy. As breast oncologists continue to refine treatment approaches, this is something to be cognizant of, Rimawi notes.

Currently, the frontline standard of care for metastatic HER2-positive breast cancer is trastuzumab (Herceptin) in combination with pertuzumab (Perjeta) and either chemotherapy or endocrine therapy. Second-line therapy is typically with the antibody drug conjugate ado-trastuzumab emtansine, or T-DM1. However, recent data suggests these agents may also have clinical benefit in earlier treatment settings.