Dr. Lin on the Treatment Landscape in HER2+ Metastatic Breast Cancer

Nancy U. Lin, MD, associate professor of medicine at Harvard Medical School; associate chief of the Division of Breast Oncology, Susan F. Smith Center for Women’s Cancers; director of the Metastatic Breast Cancer Program and senior physician at Dana-Farber Cancer Institute, discusses the treatment landscape in HER2-positive metastatic breast cancer. 

​Historically, patients with HER2-positive breast cancer received trastuzumab (Herceptin) plus pertuzumab (Perjeta) and chemotherapy in the first-line setting​, followed by ado-trastuzumab emtansine (T-DM1; Kadcyla) in the second-line setting, says Lin.

​P​rior to the phase 2 HER2CLIMB and DESTINY-Breast01 trials, third-line treatment was physician’s choice, ​explains Lin. Lapatinib (Tykerb)- or neratinib (Nerlynx)-containing regimens or trastuzumab-based combinations were often implemented in the third-line setting. 

However, results from HER2CLIMB ​revealed that tucatinib (Tukysa) plus capecitabine (Xeloda) and trastuzumab ​led to a 34% reduction in the risk of death compared with trastuzumab and capecitabine alone in patients with heavily pretreated unresectable locally advanced or metastatic HER2-positive breast cancer. 

However, these results fail to confirm where tucatinib will be placed relative to fam-trastuzumab deruxtecan-nxki (Enhertu), Lin concludes.