Clinical Pearls for HER2+ Breast Cancer Treatment


Experts provide clinical pearls to the audience on treating patients with breast cancer.

Sara Hurvitz, MD:I want you to each present 1 clinical pearl that you would recommend your community oncologist colleague be aware of. Something that you think is important regarding the data we’ve discussed tonight.

Vijayakrishna Gadi, MD, PhD: I would say rebiopsy, it’s safe and feasible. With the bystander effect that T-DXd [trastuzumab deruxtecan] is capable of, it may have more activity in a cancer that’s evolving and changing. Where its HER2 expression is uneven, heterogeneous, or lost, you might still see some activity with this drug.

Reshma Mahtani, DO:I would make sure you give antiemetic prophylaxis when you give T-DXd. We focus on the ILD [interstitial lung disease] and pneumonitis, but I think the nausea that you can get with this agent without appropriate antiemetic prophylaxis, and sometimes agents that help with delayed emesis, are helpful in keeping patients on.

Neil Iyengar, MD:I advise the use of our most effective treatments up front. Use the T-DXd when you need disease control, and use the tucatinib-based regimen when you need CNS [central nervous system] disease control. This is a disease where we see exceptional responders, and using our best treatment up front may be an opportunity for our patients.

Sara Hurvitz, MD:This has been a great discussion. We have several extra questions, one asked if we should be doing PFTs [pulmonary function tests] or DLCOs [diffusion lung capacity for carbon monoxide tests] in our patients who will be going on T-DXd. We don’t know. It’s a good idea to know your pulmonologist’s phone number when you do have a case of symptomatic ILD, but I’m not doing upfront PFTs or DLCOs, and I think there are ongoing trials to address that.

Thank you Drs Gadi, Mahtani, and Iyengar for joining us in this lively discussion on metastatic HER2-positive breast cancer brought to you by CancerNetwork®.

This transcript has been edited for clarity.

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