Current First-Line Systemic Therapy Options for HER2+ Metastatic Breast Cancer

Opinion
Video

Experts discuss considerations around first-line treatment selection for HER2-positive metastatic breast cancer, including when to diverge from the standard-of-care treatment, as well as the role of brain MRIs at diagnosis.

Manali Bhave begins by discussing first-line therapy for HER2-positive metastatic breast cancer, which is typically taxane chemotherapy (like docetaxel or paclitaxel) plus trastuzumab and pertuzumab. She cites the pivotal CLEOPATRA trial that established this dual HER2 blockade regimen as the standard of care, demonstrating significantly improved progression-free and overall survival compared to chemotherapy and trastuzumab alone.

Bhave highlights the 8-year landmark data showing an impressive 37% overall survival rate with the dual blockade regimen versus 23% in the control arm. She notes that docetaxel is preferred, but weekly paclitaxel can be used if docetaxel is not tolerated well.

When asked by Spring if alternative regimens are ever considered instead of taxane/trastuzumab/pertuzumab, Spring acknowledges the impressive CLEOPATRA results but mentions a rare case where she used trastuzumab/chemotherapy without pertuzumab for an oligometastatic presentation in an older patient never previously exposed to HER2 therapy.

They then discuss getting baseline brain MRIs in HER2+ metastatic breast cancer. Bhave does not routinely get them but considers it in very high-risk cases with aggressive disease and rapid metastatic recurrence after adjuvant therapy, as that could guide using regimens with good CNS penetration. Spring agrees with this approach.

This summary was AI-generated and edited for clarity.

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