Standard of Care Regimens for Second-Line Treatment of HER2+ Metastatic Breast Cancer
Laura Spring, MD, and Manali Bhave, MD, discuss findings from the DESTINY-Breast03 trial and how these results have led them to adopt T-DM1 as the new standard of care over lapatinib/capecitabine for second-line treatment of HER2-positive metastatic breast cancer after progression on first-line trastuzumab and a taxane.
EP: 1.Clinical Scenario: A 57-Year-Old Woman With Metastatic Breast Cancer
EP: 2.Current First-Line Systemic Therapy Options for HER2+ Metastatic Breast Cancer
EP: 3.Key Clinical Trials in the First-Line Treatment of HER2+ Metastatic Breast Cancer
EP: 4.Standard of Care Regimens for Second-Line Treatment of HER2+ Metastatic Breast Cancer
EP: 5.Sequencing Therapies in the Third-Line and Beyond for Patients With HER2+ Metastatic Breast Cancer
EP: 6.Clinical Scenario: A 65-Year-Old Post-Menopausal Woman With Metastatic Breast Cancer
EP: 7.Approaches to Mutation Testing for Patients With HR+/HER2-low mBC and ET-Resistant Disease
EP: 8.Factors for Consideration When Choosing Among Options for Patients with ET-resistant ER+/HER2- mBC
EP: 9.Sequencing Antibody-Drug Conjugates (ADCs) in HR+/HER2-Low Metastatic Breast Cancer
EP: 10.Exciting Data in the Treatment of HER2-low from SABCS 2023
The discussion moves to second-line treatment for this patient who progressed after around 18 months on first-line taxane, trastuzumab and pertuzumab.
Spring states that based on the groundbreaking DESTINY-Breast03 trial, trastuzumab deruxtecan (T-DXd) is now the standard second-line treatment over T-DM1. She highlights the impressive median treatment duration of 18.2 months for T-DXd versus 6.9 months for T-DM1, and the 36% reduced risk of death with T-DXd.
However, Spring notes there may be scenarios where T-DM1 is preferred, such as a patient with prior pneumonitis who may be higher risk for the interstitial lung disease seen with T-DXd. Patient preference can also play a role if they are more concerned about the side effect profile of T-DXd like alopecia compared to T-DM1. Factors like pace of disease, sites of metastases, and duration of first-line response help guide the decision.
Bhave agrees T-DXd is their standard second-line choice but emphasizes the need to be upfront with patients about potential toxicities like fatigue, nausea requiring dose modifications, and recommends aggressive anti-nausea prophylaxis. Both agree following the dose modification guidelines for T-DXd is important for tolerability, as the fatigue can be significant with longer use.
In summary, while T-DXd has become the preferred second-line option, there is still a role for T-DM1 in certain clinical scenarios or based on patient preference and anticipating side effect management.
This summary was AI-generated and edited for clarity.
