ESMO Breast 2021 | Sequencing therapies in HER2+ breast cancer
With the development of novel targeted agents in the metastatic HER2+ space, the question of how to sequence these therapies is an important one in breast cancer. In this video, Thomas Bachelot, MD, PhD, Centre Léon Bérard, Lyon, France, discusses how to sequence targeted therapies, including tucatinib, neratinib, margetuximab and trastuzumab deruxtecan (TDxd) in patients with advanced HER2+ breast cancer. This interview took place at the virtual European Society for Medical Oncology (ESMO) Breast Cancer Congress 2021.
Transcript (edited for clarity)
So, at the present time among the drugs that we can use that are not commercialized yet in Europe but are coming in, there’s the trastuzumab deruxtecan, there is tucatinib. That the two most important are those two drugs. Both have shown in early clinical trials for the trastuzumab deruxtecan, because we are still waiting for the randomized study. And in a very nice, randomized study for the tucatinib, the HER2CLIMB study that shows an important in overall survival for certain patients...
So, at the present time among the drugs that we can use that are not commercialized yet in Europe but are coming in, there’s the trastuzumab deruxtecan, there is tucatinib. That the two most important are those two drugs. Both have shown in early clinical trials for the trastuzumab deruxtecan, because we are still waiting for the randomized study. And in a very nice, randomized study for the tucatinib, the HER2CLIMB study that shows an important in overall survival for certain patients.
So that there is those two compounds are clearly efficient for patient in third or fourth-line after the multiple treatment. Som I will use both, there is not really recommendation to use one before the other one. Maybe tucatinib have more, for the moment, tucatinib have more data or more evidence to use it after operation and T-DM1 than the trastuzumab deruxtecan. So, maybe I will mostly use tucatinib-trastuzumab capecitabine in third line, then T-DXd in fourth.
With regard for the other one, neratinib, the study is very poor. It’s a pain, because it’s a nice drug. But the Nerlynx trial is not very impressive when you compare that to HER2CLIMB, or even to the result with T-DXd that is very impressive. So neratinib, I won’t use it, I will prefer tucatinib definitively. So, maybe if patient have received everything, we can try neratinib, why not? But I’m not very- with the advent of tucatinib and T-Dxd, I don’t really know where we’re going to put neratinib.
And with regard to, excuse me, this new HER2 inhibitor [inaudible] I don’t remember its name. Margetuximab. Now with regard to margetuximab, is that the same thing. The randomized study is nice, but it’s, the result are much less impressive than the one that have been shown in HER2CLIMB. There’s no improvement in overall survival, for example. So, it’s not very exciting compound for that one. So, we, I don’t really know where its position is right now.
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