Debu Tripathy, MD, professor of medicine and co-leader of the Women’s Cancer Program at the University of Southern California Norris Comprehensive Cancer Center, discusses the order that various HER2 targeted therapies should given to breast cancer patients.

Tripathy explains that a hard-set guideline has not been established. He describes that it has become increasingly more likely that a patient will receive trastuzumab (Herceptin) in the adjuvant setting and that because of this HER2/neu positive recurrences usually have already received the drug, warranting a new approach.

The two main choices for patients with HER2 overexpression is trastuzumab with a different chemotherapy or lapatinib (Tykerb) with capecitabine (Xeloda). It has not been established which treatment should be used first. There is evidence to support using either drug. In many cases it is acceptable to use one drug first or to interchange treatments.