Sequencing Therapy in MBC in Second Line and Beyond

EP: 1.Patient Profile 1: A Patient With HER2+ Metastatic BC Treated With T-DXd who Develops ILD

EP: 2.Adverse Event Management With T-DXd in Patients With Breast or Gastric Cancers

EP: 3.Management of Interstitial Lung Disease Related to T-DXd in Breast or Gastric Cancers

EP: 4.Selecting Appropriate Patients with MBC for T-DXd and Counseling for AEs

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EP: 5.Sequencing Therapy in MBC in Second Line and Beyond

EP: 6.Patient Profile 2: A Patient With HER2+ MBC Treated With T-DM1 who Develops Neuropathy

EP: 7.Role of T-DM1 in Patients With HER2+ Breast and Gastric Cancers

EP: 8.Managing AEs With Trastuzumab Emtansine in Breast and Gastric Cancers

EP: 9.A Brief Review of Ongoing Clinical Trials of ADCs in Breast Cancer

EP: 10.Patient Profile 3: A Patient with HER2+ Gastric Cancer Treated With T-DXd–who Develops Neutropenia

EP: 11.First- and Second-Line Treatment Options for HER2+ Gastric Cancer

EP: 12.T-DXd in HER2+ Gastric Cancer: Managing Neutropenia and Other AEs

EP: 13.Ongoing Clinical Trials With T-DXd in HER2+ Gastric Cancer

EP: 14.Patient Profile 4: A Patient with HER2+ Gastric Cancer Treated With T-DXd Who Develops Diarrhea

EP: 15.T-DXd in HER2+ Gastric Cancer: Educating Patients About Risk of Diarrhea

EP: 16.Role of the Broader Healthcare Team in Managing AEs Associated With T-DXd

EP: 17.Novel Clinical Trials With ADCs in Gastric Cancer

EP: 18.Practice Pearls for Toxicity Management With ADC Therapy in Breast and Gastric Cancer

Transcript:

Sarah Donahue, MPH, NP, AOCNP: In the second-line setting, there are a lot of options out there. We just talked about a patient who may not be able to tolerate trastuzumab deruxtecan because of their lung issues. But let’s say they don’t have any lung issues, and you’re trying to choose what to use. Are you now using trastuzumab deruxtecan as your second line? Is that what you’re seeing in breast cancer, Jamie?

Jamie Carroll, APRN, CNP, MSN: Yeah, absolutely. With new data coming out from the DESTINY-Breast03 study, we’ve moved up trastuzumab deruxtecan to the second line. Then the question is, what about in the third line and beyond? What do you use there? It’s dealer’s choice, right? Once a patient is having progression on trastuzumab deruxtecan, do we use T-DM1 [trastuzumab emtansine]? Previously, T-DM1 [trastuzumab emtansine] was the second line, and then we thought of trastuzumab deruxtecan in the third line. But we don’t have data. If we move trastuzumab deruxtecan to the second line, we don’t know how effective T-DM1 [trastuzumab emtansine] will be after progression on trastuzumab deruxtecan.

Additionally, we’ve got TKIs [tyrosine kinase inhibitors]: tucatinib-capecitabine-trastuzumab, lapatinib-capecitabine-trastuzumab. The landscape of HER2 [human epidermal growth factor receptor 2]–positive breast cancer has changed significantly in the last couple of years, and it’s opened up options for our patients, which is awesome.

Sarah Donahue, MPH, NP, AOCNP: It’s definitely opened up many options. What about with patients with progressive brain metastases? Do you have a preference for using trastuzumab deruxtecan over tucatinib-capecitabine-trastuzumab if you were at that point?

Jamie Carroll, APRN, CNP, MSN: That’s a great question. We tend to use tucatinib, knowing that it’s going to penetrate the blood-brain barrier. I’ve seen patients who have active brain metastases get smaller with tucatinib after a short period of time. I had 1 patient who unfortunately lost her insurance and ran out of tucatinib. Eleven days later, she had progressive brain metastases, so I knew it was working effectively in her. That’s the choice that I would have with brain metastases.

Sarah Donahue, MPH, NP, AOCNP: In gastric cancer, what line is the trastuzumab deruxtecan? Liz?

Elizabeth Prechtel Dunphy, DNP, CRNP, AOCN: Insecond-line therapy, usually following a progression of fluoropyrimidine, something like FOLFOX—5-FU [5-fluorouracil], leucovorin, oxaliplatin—potentially with pembrolizumab if they have PD-L1 positivity or an increased CPS [cognitive performance scale] score.

Transcript edited for clarity.