Treatment Selection and Sequencing Strategies in HER2+ Metastatic Breast Cancer

Experts discuss the patient case of Janet, a 58-year-old with her 2 positive metastatic breast cancer, and after 14 months on the Cleopatra regimen with taxane, Trastuzumab, and Pertuzumab, and 11 months on Tdxd. As her disease is now progressing, so she needs 3rd line treatment. But despite some fatigue, she remains active with work and Yoga and her brain, MRIs are clear.

Experts discuss treatment options for HER2-positive metastatic breast cancer following progression on trastuzumab deruxtecan (T-DXd), weighing real-world data on tucatinib-capecitabine-trastuzumab versus T-DM1, considering factors such as resistance mechanisms, administration preferences, and side effect management.

Experts discuss how, discuss patient experiences with an oral chemotherapy regimen, highlighting benefits like treatment autonomy, challenges such as pill burden and gastrointestinal toxicities, and the importance of proactive side effect management and patient education.

Experts discuss how, nearly half of patients diagnoses with HER-2 positive metastatic brain cancer do develop brain metastasis. It is thought that larger molecule treatments such as the monoclonal antibodies likely do not cross an intact blood brain barrier which is often why patients develop brain metastases

Experts discuss how, there is a role for SRS in treating brain metastases such as if a patient were to have a large singular brain metastasis that is causing symptoms such as seizures of neurological decline, that SRS could be a warranted treatment.

Experts discuss how, it is crucial to approach treatment strategies with both compassion and transparency. It is important to explain the complexity of the situation and maintain clear and accessible language when discussing treatment strategies with patients and their families.