Second- and Third-Line Therapies in HER2+ Metastatic Breast Cancer

Hatem Soliman, MD, an associate member of the breast oncology program, and medical director of the clinical trials office, Moffitt Cancer Center, discusses second- and third-line strategies being used for the treatment of patients with HER2-positive metastatic breast cancer.

According to Soliman, trastuzumab emtansine (Kadcyla) was previously used as the standard of care option for this patient population in the second- or third-line until a trial that showed superior activity with fam-trastuzumab deruxtecan-nxki (Enhertu).

Now, trastuzumab deruxtecan is the preferred second-line treatment for patients in the HER2-positive metastatic breast cancer setting.

Another option being evaluated in this space is the triplet combination of capecitabine (Xeloda) plus trastuzumab plus tucatinib (Tukysa).

Transcription:

0:10 | Based on the DESTINY-BREAST03 data [NCT03529110], showed that the current standard of care that was looked at the time was the use of basically another antibody drug conjugate called [trastuzumab emtansine], which had a different payload. It was a different chemical payload than what is on trastuzumab deruxtecan and that was the standard of care for a number of years following the combination of taxane, pertuzumab [Perjeta], and [trastuzumab]. However, as a result of the head-to-head trial [in which trastuzumab emtansine] was a control, the activity was superior dramatically in the HER2-containing arm of [trastuzumab deruxtecan]. That became now the preferred second-line therapy for most patients with HER2-positive breast cancer in the metastatic setting and displaced the use of [trastuzumab emtansine] going forward.

1:14 | Now in our guidelines, we will use trastuzumab deruxtecan in the second-line setting, and then basically also, we have a consideration for another combination, as well as for a specific group of patients, either in the second-line or in the third-line setting. That triple combination of capecitabine plus trastuzumab plus tucatinib, which was studied in the HER2CLIMB [NCT02614794]. That is another one of the options that we look at in that second- and third-line space.