Dr Gatti-Mays Highlights Treatment Algorithms in mHER2+ Breast Cancer

Margaret Gatti-Mays, MD, MPH, FACP, Pelotonia Institute for Immuno-Oncology, The Ohio State University, discusses treatment algorithms for metastatic HER2+ breast cancer, a topic discussed at the 2021 Great Debates and Updates in Women's Oncology Meeting. 

Transcript

Good morning, my name is Margaret Gatti-Mays. I am a medical oncologist from the Pelotonia Institute for Immuno-Oncology in the Ohio State University. I am here to discuss and piggyback off of some of the discussions from the recent Women's Oncology updates.

Specifically today, what I am going to be doing is talking about some of the treatment algorithms for HER2-positive breast cancer in the metastatic setting.

Obviously, with first and second-line setting, I think most oncologists will start with the CLEOPATRA regimen with a taxane, Herceptin, and pertuzumab, with second line currently being at least T-DM1 or Kadcyla. However, in the third-line setting, there is now a plethora of options which an oncologist can choose from.

I think many patient-related factors go into the selection of a third-line regimen. For example, if a patient is known to have a brain metastasis, that has either been recently treated, or if there is concern for brain metastases, the recently approved regimen from the HER2CLIMB trial with tucatinib, capecitabine, and trastuzumab, I think is probably the natural choice for a patient again with brain metastases.

In patients who perhaps have larger-volume disease or progressed on T-DM1 without concern for brain metastases, it seems that the natural selection at this point would likely be in HER2.

In patients who have perhaps lower-volume disease following progression on T-DM1, another reasonable option would be trastuzumab and capecitabine. Obviously, with the use of capecitabine, this allows an oral option for a patient and again may be reasonable for a patient with lower-volume disease.

Then of course, there is also the more recently approved monoclonal antibody, margetuximab, which can be used with your selection of chemotherapy and again with the selection of chemotherapy really depending on which agents they have previously received. That can either be given with capecitabine, eribulin, gemcitabine, or vinorelbine.

I think what is exciting in the setting of metastatic HER2-positive disease at this point is that there really are many, many options for third-line and beyond in this setting, and it really does allow us as oncologists to tailor the treatment to best fit our patient that we are seeing.