Dr. Meisel on Sequencing Considerations in First- and Second-Line HER2+ Breast Cancer

Jane L. Meisel, MD, associate professor, Departments of Hematology and Medical Oncology and Gynecology & Obstetrics, Winship Cancer Institute, Emory University School of Medicine, discusses sequencing considerations in the first- and second-line settings of HER2-positive breast cancer.

Although treatment selection should be individualized for every patient, the first-line standard of care for the majority of patients with HER2-positive breast cancer remains chemotherapy plus trastuzumab (Herceptin) and pertuzumab (Perjeta), says Meisel. Additionally, ado-trastuzumab emtansine (T-DM1; Kadcyla) should be considered for most patients in the second-line setting.

However, patients with significant brain metastases could be given tucatinib (Tukysa) plus trastuzumab and capecitabine (Xeloda) prior to T-DM1, says Meisel. Although the phase 2 HER2CLIMB trial evaluated this combination as a third-line treatment for patients, the FDA indication states it can be used in patients who received at least 1 anti–HER2-based regimen in the metastatic setting. Looking forward, tucatinib is being evaluated in combination with T-DM1 as a second-line option for patients with metastatic HER2-positive breast cancer in the ongoing phase 3 HER2CLIMB-02 trial (NCT03975647), concludes Meisel.