Advice for Community Physicians on Managing HER2+ Breast Cancer


Closing out their review on treatment strategies for HER2-expressing breast cancer, panelists share practical advice for the community setting.


Aditya Bardia, MD, MPH: Finally, in terms of closing thoughts, we have a new drug, T-DXd [trastuzumab deruxtecan], and a new subclass of breast cancer, HER2 low. Any recommendations for the community oncologist who sees all different types of breast cancer? Give one piece of advice. We'll start with Virginia. What’s one recommendation for the community oncologist in this setting?

Virginia Kaklamani, MD: Don't classify HER2 as positive or negative anymore. There is the HER2 low category.

Aditya Bardia, MD, MPH: Well said. Sarah?

Sara A. Hurvitz, MD: That was a really good one. Keep your eyes open for elacestrant and capivasertib. Those are going to be the next 2 approvals.

Aditya Bardia, MD, MPH: Michelle?

S. Michelle Shiller, DO, AP/CP, MGP: I would recommend that you talk to your pathologist any time you have questions and engage a very robust discussion with them about testing and really make sure that you're able to communicate clearly with one another. If there's something that they're reporting that doesn't make sense, talk to them about how you can improve that.

Aditya Bardia, MD, MPH: Communication. That's a great point. It's critical. And finally, Heather. Any piece of advice?

Heather McArthur, MD: I would add vigilance around toxicity monitoring with these ADCs [antibody-drug conjugates]. We've been talking about trastuzumab deruxtecan. Early detection of any whiff of interstitial lung disease is critically important. I've changed the frequency of scans that I do in my own practice for those patients.

Aditya Bardia, MD, MPH: That's great. Thank you all. Those were good points in terms of classification, newer agents, communication, and management of toxicity. Thank you so much for providing your feedback and comments related to this very exciting subgroup of breast cancer, HER2-low breast cancer. Thank you.

Transcript edited for clarity.

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