Optimizing Care in HER2+ Breast Cancer: Integrating Fertility Preservation and Advanced Treatment Approaches

Panelists discuss how treatment strategies for triple-positive breast cancer (hormone receptor [HR] positive and HER2 positive) differ from those for hormone receptor–negative, HER2-positive disease, with emphasis on balancing endocrine therapy, HER2-targeted therapy, and chemotherapy.

Panelists discuss how ovarian suppression combined with endocrine therapy shows benefits for premenopausal patients with triple-positive breast cancer, particularly in younger, high-risk populations.

Panelists discuss how different gonadotropin-releasing hormone (GnRH) agonists like leuprolide and goserelin are equally efficacious for ovarian function suppression but differ in administration methods, needle size, and patient comfort.

Panelists discuss how the treatment landscape for early HER2-positive metastatic breast cancer has evolved, with taxane-pertuzumab-trastuzumab as first-line standard of care and T-DXd supplanting T-DM1 as the preferred second-line treatment.

Panelists discuss how third-line treatment options after T-DXd progression include T-DM1 and the HER2CLIMB regimen (tucatinib-capecitabine-trastuzumab), with consideration of brain metastases as a key factor in treatment selection.

Panelists discuss how fourth-line treatment options include margetuximab (which interacts better with the immune system), neratinib-capecitabine (an irreversible pan-HER inhibitor), and antibody-drug conjugates (ADCs) with different payloads, though toxicity profiles must be considered.

Panelists discuss how treatment decisions in later-line settings should incorporate clinical trials, patient preferences regarding quality of life, medication scheduling, financial considerations, and previous adverse effect experiences, while also addressing special considerations for brain metastases.