ASCO 2022 | Sequencing HER2-targeted therapies in breast cancer
Erika Hamilton, MD, Sarah Cannon Research Institute, Nashville, TN, reflects on the expanding treatment landscape of HER2-positive breast cancer which brings forward the question of how to best sequence HER2-targeting agents, including novel agents such as trastuzumab deruxtecan (T-DXd), tucatinib, and trastuzumab emtansine (T-DM1) in later lines of treatment. This interview took place at the American Society of Clinical Oncology (ASCO) 2022 Annual Meeting in Chicago, IL.
Transcript (edited for clarity)
Sequencing among our ADCs is definitely getting tricky and not just in the HER2 space. So right now our standard first line treatment is taxane with trastuzumab and pertuzumab. Now, patients may not get this if they get that in the neoadjuvant setting and then relapse very quickly within 12 months of already receiving it. But for most patients, that’s typically the way it goes. And then we’re probably thinking about trastuzumab deruxtecan in the second line...
Sequencing among our ADCs is definitely getting tricky and not just in the HER2 space. So right now our standard first line treatment is taxane with trastuzumab and pertuzumab. Now, patients may not get this if they get that in the neoadjuvant setting and then relapse very quickly within 12 months of already receiving it. But for most patients, that’s typically the way it goes. And then we’re probably thinking about trastuzumab deruxtecan in the second line. And then third line and beyond is a little bit more up near. I personally am using a lot of capecitabine with trastuzumab and tucatanib in the third line. It improved overall survival. It’s very good drug for brain mets. And we’re hoping, although we don’t know this yet, that it might even be preventative for brain mets. And then we certainly can cycle back and think about something like T-DM1 as well for our patients.
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