Dr. Jhaveri on Sequencing Treatments in Metastatic HER2+ Breast Cancer

Komal Jhaveri, MD, FACP, a medical oncologist at Memorial Sloan Kettering Cancer Center, discusses sequencing treatments for patients with metastatic HER2-positive breast cancer.

When a patient begins frontline treatment, Jhaveri recommends the use of trastuzumab (Herceptin), pertuzumab (Perjeta), and chemotherapy. Moreover, ado-trastuzumab emtansine (Kadcyla) can be used in the second-line setting, based on the results of the EMILIA trial, which showed a benefit over lapatinib (Tykerb) plus capecitabine, Jhaveria says. 

There are 3 drugs currently available that have been approved by the FDA to treat patients in the third-line setting, including fam-trastuzumab deruxtecan-nxki (Enhertu), tucatinib (Tukysa) with capecitabine and trastuzumab, and neratinib (Nerlynx) plus capecitabine.

The treatment landscape has become crowded in light of these approvals, although Jhaveri emphasizes that this is a good problem to have. Due to this, it's important for physicians to consider characteristics of each individual patients to make optimal treatment decisions; toxicity profiles should also be taken into consideration, Jhaveri concludes.