HER2-positive breast cancer

The treatment of HER2-positive (HER2+) metastatic breast cancer (mBC) has drastically evolved with the clinical success and approval of several HER2-directed therapies, including trastuzumab, pertuzumab, trastuzumab emtansine (T-DM1), and lapatinib. Standard of care first-line therapy for HER2+ mBC is the combination of pertuzumab, trastuzumab, and a taxane. After progression, T-DM1 is the most supported choice for second-line therapy. Once patients have received trastuzumab, pertuzumab, and T-DM1 in the metastatic setting, there is little evidence for the optimal sequence or duration of HER2-directed therapy, and clinical trials should be considered. Continuing HER2-targeted therapies following progression on trastuzumab has shown benefit. Lapatinib combination therapies are clinically efficacious in heavily pretreated populations. Sequential single-agent chemotherapy with trastuzumab is a reasonable approach in later lines of therapy.

Duke Scholars

Author Sarah Sammons Medicine, Medical Oncology

Author Kimberly Lynn Blackwell Medicine, Medical Oncology