Clinical Challenges Associated With HER2-Positive Breast Cancer

Three new therapies for HER-2 positive breast cancer have been approved. The standard treatment for this form of advanced breast of cancer is a combination of chemotherapy, trastuzumab, and pertuzumab, which are monoclonal antibodies. The second line of treatment includes the antibody-drug conjugate known as T-DMI.

When these drugs were incorporated in metastatic breast cancer treatment, patients reported substantial improvements in their outcomes. However, later on, the patients would develop resistance to the therapies, calling for the need for new treatments when the others have failed.

The FDA approval of the three therapies has changed the treatment approach for metastatic HER2- positive breast cancer.

The three therapies include;

  • Neratinib (Nerlynx) which is used in combination with capecitabine for patients with metastatic HER2-positive breast cancer who’ve undergone prior anti-HER2 based regimens.
  • Tucanitib (Tukysa) for use in combination with chemotherapy to treat advanced unresectable HER2-positive breast cancer, including metastatic brain patients who’ve received prior regimens in the metastatic setting.
  • Fam-trastuzumab deruxtecan-nxki (Enhertu) that treats adult patients with metastatic HER2-positive breast cancer who’ve received prior regimens. Trastuzumab deruxtecan is an active version of T-DMI that was approved based on a clinical trial.

However, physicians should be aware of potential symptoms of pneumonitis when using these drugs and treat it on time.

From the trial, researchers noted an improved progression-free survival in patients who used tucatinib together with trastuzumab and capecitabine.

More trials are ongoing to make tucatinib a primary line of therapy. They’re evaluating it in combination with T-DMI to have it as a first treatment option for advanced breast cancer. The same drug is also under investigation for use in combination with capecitabine and trastuzumab to help treat patients with leptomeningeal disease, a rare metastatic brain cancer complication in which cancer cells spread to meninges around the spinal cord and brain.