Dr. Gradishar on Integrating Novel Options Into the HER2+ Breast Cancer Treatment Algorithm

William Gradishar, MD, chief of hematology and oncology, Department of Medicine, Betsy Bramsen Professorship of Breast Oncology, and professor of medicine, hematology and oncology, Northwestern University Feinberg School of Medicine, discusses factors to consider when determining the optimal treatment of patients with HER2-positive breast cancer.

When a new therapy is introduced into the treatment armamentarium for this patient population, it is important to examine whether the agent will be effective in earlier phases of disease, according to Gradishar. Ongoing studies are examining ado-trastuzumab emtansine (T-DM1; Kadcyla) vs fam-trastuzumab deruxtecan-nxki (Enhertu), and tucatinib (Tukysa) is being examined in combination with T-DM1, Gradishar says. Results from these studies could impact how these drugs are utilized in the treatment of patients, Gradishar notes. 

In terms of integrating novel therapies into the treatment algorithm, it is important to consider any prior therapies the patient has received and how recently, Gradishar adds. For example, if patient who has residual disease postoperatively is given T-DM1, that will factor into whether they receive the agent again upon the development of metastatic disease or whether they should receive a newer treatment option, Gradishar explains. Additionally, whether a patient develops brain metastases is an important factor to consider when deciding treatment. If these metastases are present, tucatinib would be a beneficial option, Gradishar concludes.