Dr Tiwari on the Current Treatment Paradigms for HER2-Positive and HER2-Low Breast Cancers

Shruti Tiwari, MD, medical oncologist, Virginia Cancer Specialists, discusses how the treatment paradigm for HER2-low breast cancer has evolved in recent years.

The treatment paradigm for HER2-low breast cancer has evolved significantly in recent years, marking a transformative period in oncology, Tiwari begins. One of the most exciting developments in this field is the introduction of fam-trastuzumab deruxtecan-nxki (T-DXd; Enhertu), a drug that has demonstrated impressive efficacy in treating HER2-low cancers, Tiwari says. This advancement is particularly noteworthy as it has shown positive results in both estrogen receptor (ER)-positive/HER2-low and ER-negative/HER2-low breast cancers, broadening the scope of effective treatments available for these patient groups, she reports.

For triple-negative breast cancer (TNBC), the availability of a non-chemotherapy option, such as T-DXd, following initial chemotherapy is a significant breakthrough, according to Tiwari. TNBC is difficult to treat, and T-DXD, a targeted, well-tolerated drug, is a substantial improvement over traditional therapies, she elucidates. This drug provides a new line of defense and enhances the quality of life for patients who have already undergone rigorous chemotherapy treatments, Tiwari adds.

Moreover, T-DXd is a valuable addition to the treatment paradigm for ER-positive, HER2-positive breast cancer, Tiwari notes. Transitioning from one chemotherapy line to another can be particularly challenging for these patients, Tiwari explains. This agent is a manageable treatment option that can also effectively target HER2-low cancers without the harsh adverse effects typically associated with chemotherapy, she continues. Another significant addition to the ER-positive, HER2-negative/HER2-low breast cancer treatment armamentarium is sacituzumab govitecan-hziy (Trodelvy), Tiwari explains. These drugs provide oncologists with more tools to combat HER2-low breast cancers, making treatment plans more flexible and personalized, Tiwari emphasizes.

With multiple effective therapies available, it is crucial to establish the best order of administration to maximize patient outcomes, Tiwari says. This consideration involves understanding the unique needs of each patient and the specific characteristics of their cancer to tailor the most effective treatment strategy, she says.

Overall, the availability of T-DXd and sacituzumab govitecan represents a significant leap forward, providing targeted, effective, and well-tolerated treatment alternatives for patients with HER2-positive and HER2-low breast cancer, Tiwari concludes.