Dr. Tripathy on Decision-Making for Sequencing Therapies for HER2-Positive MBC

Debu Tripathy, MD, co-leader, Women's Cancer Program, University of Southern California Norris Comprehensive Cancer Center, discusses a decision-making framework for sequencing therapies for HER2-positive metastatic breast cancer.

While there are some broad frameworks in place for decision-making, Tripathy says, many patients do not fit easily into those frameworks. In the first-line, patients who have not been treated with trastuzumab (or were treated with trastuzumab over one year ago) should receive a combination of trastuzumab, pertuzumab, and docetaxel or another taxane. The question then remains as to how this group should be treated next, Tripathy says.

It is known that T-DM1 is superior to capecitabine and lapatinib, but again, questions remain regarding what should be done when a patient progresses in a short period of time. Tripathy says oncologists can treat based on phase II results, but there is no way to definitively know what is best for a given situation.