Her2+   

Questions discussed in this category



The FDA recently approved trastuzumab deruxtecan (T-DXd) in the second line setting. Given the results of DESTINY-Breast03, what is now the role of TD...

Patient was initially ER positive, HER2 positive. Currently she is on letrozole. Recurrence is ER/PR negative and HER2 positive and developed almost 2...

Given data from metastatic breast cancer trials that show benefit with continuing trastuzumab despite progression.

Which regimen is preferred in second line for these patients? What is the efficacy of TDXd vs tucatinib in CNS metastases?    

Would you obtain baseline PFT on all patients or only selected high risk patients? Would you repeat PFTs regularly or only if clinically symptomatic?&...

Given strong TDXd efficacy in these patients is there a role to use it earlier than 2nd line? How does prior Her2-directed and/or taxane therapy...

Patient is young. Bilirubin normalizes when tucatinib is held, but again increases to grade 2 when it is restarted. Evaluation for hemolysis was negat...

What do you do if LFTs are elevated after one dose of neoadjuvant TCHP (highest ALT >13 times upper limit of normal, normal bilirubin) with prior n...

Although grade 3 toxicity rates were low, ~10.5% experience some degree of ILD, are there strategies to reduce risk before treatment starts? Are ther...

Does this change for PDL1 1-49% vs >50%? Will you be more likely to employ other checkpoint inhibitors before use of HER2 targeting therapy? Or sta...

What combination of fluoropyrimidine, PD-1 inhibitor, or trastuzumab do you use?

KEYNOTE 811 showed improved response rate with the addition of pembrolizumab, but very few patients in this study had low PDL1.

Would you consider neoadjuvant or adjuvant treatment and if so, which therapies? Patient initially had pT2N0 disease and recurrent disease is also ER+...

How are you thinking about sequencing therapies for these patients (IO vs chemo vs T-Dxd)? Are the data from DESTINY-Lung01 strong enough to warrant e...

Can patients be re-challenged after developing ILD? Is the toxicity seen with T-Dxd a potential barrier to use?  Do you feel the dosing used in...

The patient has extensive liver metastases and a high bilirubin. She has not received any prior systemic therapy in the metastatic setting. 

Patient had an initial tumor response to TCHP, but still had significant residual disease present, including positive lymph nodes and residual breast ...

<40y/o female w/ initial biopsy showing G3 IDC with 80% ER+, 90% PR+, and HER2 positive (IHC 2+; 1.6 HER2/CEP17 ratio and 6.3 HER2 copies/nucleus.)...

Would you choose to incorporate HER2-targeting agents, chemotherapy, endocrine therapy, or a mix of these?

How would you approach additional systemic therapy? Would the clinical stage of the cancer affect your management?

Patient had a clinical T2N0 cancer at diagnosis, completed 6 cycles TCHP, and had 0.2mm residual disease with 80% cellularity, negative sentinel node.

2 populations of cells with 95% negative by FISH (ratio 1.07) and 5% positive by FISH (ratio 10)

How would your treatment change given pCR rates are reportedly much lower in triple positive patients?

Given the changing landscape of treatment, some patients may have already received capecitabine previously.  Would this impact your treatment rec...

Would you consider an anthracycline based substitution vs changing to nab-paclitaxel or a combination with platinum agent?

This patient underwent mastectomy and ALND (10/28 positive lymph nodes). Immediately following axillary LN dissection (and prior to radiation) imaging...

How would this change if the patient had metastatic HR+,HER2- breast cancer and now has symptomatic pancytopenia secondary to BM involvement after TCH...

The APT trial reported excellent DFS, OS and RFI for tumors <=3cm but few were smaller T2s (2-3 cm) and few were >70 years old.

It is included in favorable histologies on NCCN, but no mention of how to treat based off HER2 status.

If yes, would you still recommend dual HER2 directed therapy? After the TRYPHAENA trial, neoadjuvant therapy with dual HER2 directed therapy has beco...

Neratinib was studied following adjuvant trastuzumab. Do you extrapolate that data to give neratinib to patients who have received adjuvant T-DM1 inst...

Clinical T1c patients were included in the KATHERINE trial that often are treated with adjuvant paclitaxel and trastuzumab

One such patient progressed through trastuzumab/pertuzumab/letrozole and TDM1 alone.  How would you combine ER+ approaches (eg CDK 4/6 inhibitor ...

The NEJM 2015 paper by Tolaney et al only included 1.5% of patients with micrometastases.

Would you do this for ER+ patients? According to the PERSEPHONE trial presented on ASCO 2018, in HER2+, non-metastatic breast cancer, 6 months Hercep...

Would you consider using CKD inhibitors upfront in triple positive breast cancer previously treated with chemotherapy, endocrine therapy, and Hercepti...

Would you consider using ckd inhibitors in triple positive breast cancer previously treated with chemotherapy, endocrine therapy, and Herceptin? NCCN ...

The FDA recently approved neratinib based on data from the ExteNET trial; however, benefit appears modest and the risk of toxicity is not low.

Do you ever consider de-escalating or stopping therapy in this situation? What is your approach to this conversation?


Papers discussed in this category


Am J Transl Res, 2019 Sep 15

Breast cancer research : BCR, 2009

Cancer cell, 2012-10-16

Cancer cell, 2016-03-14

Cancer discovery, 2016-07

Cancer, 2015-12-15

Lancet (London, England), 2009-12-19

The Lancet. Oncology, 2014-06

The New England journal of medicine, 2012-11-08

J. Clin. Oncol.,

The New England journal of medicine, 2012-01-12

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-10-10

N Engl J Med,

N Engl J Med, 2019 Dec 11

Annals of oncology : official journal of the European Society for Medical Oncology, 2015-01

Annals of oncology : official journal of the European Society for Medical Oncology, 2014-06

Journal of gastrointestinal oncology, 2016-08

The Lancet. Oncology, 2014-10

Lancet, 2010 Aug 19

N Engl J Med, 2020 May 29

J Clin Oncol, 2020 Mar 24

The New England journal of medicine, 2015-02-19

Cochrane Database Syst Rev, 2008 Apr 16

Eur. J. Cancer, 2013 May 22

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2006-09-01

N Engl J Med, 2015 Jan 8

N. Engl. J. Med.,

N. Engl. J. Med., 2017-07-13

Annals of oncology : official journal of the European Society for Medical Oncology, 2013-09

Lancet Oncol., 2018 Nov 06

Lancet (London, England), 2014-07-12

Lancet Oncol., 2012-01-01

The Lancet. Oncology, 2013-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-01-01

Lancet Oncol., 2014-06-01

Lancet Oncol., 2013 Dec 19

The Lancet. Oncology, 2017-06

The New England journal of medicine, 2019-02-14

The Lancet. Oncology, 2016-03

Lancet Oncol., 2017 Feb 24

Eur. J. Cancer, 2017 May 03

N Engl J Med, 2011 Oct 6

Journal of neurosurgery, 2019-02-08

Breast cancer research and treatment, 2018-06

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-08-01

The Lancet. Oncology, 2017-12

Breast, 2013 Dec 22

Breast, 2015 Oct 09

Lancet,

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2013-07-20

Curr Treat Options Oncol, 2019 Mar 14

Breast Cancer, 2016 Feb 13

Clinical cancer research : an official journal of the American Association for Cancer Research, 2009-02-15

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-05-01

The Lancet. Oncology, 2018-07

N. Engl. J. Med., 2019 Dec 11

Anticancer Res.,

N Engl J Med, 2021 Sep 18

The New England journal of medicine, 2018-05-31

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-07-01

The New England journal of medicine, 2018-07-12

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2010-04-20

J. Clin. Oncol., 2019 Oct 16

Lancet Oncol., 2020 Mar 12

The Lancet. Oncology, 2017-08

Breast cancer research and treatment, 2014-11

The oncologist, 2013

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011-11-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-04-01

Cancer Treat Rev, 2022 Mar 12

Breast Cancer Res. Treat., 2017 Mar 21

Clinical cancer research : an official journal of the American Association for Cancer Research, 2009-12-01

Ann. Oncol., 2013-12-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2012-07-20

J. Clin. Oncol., 2009 Sep 28

Lancet Oncol, 2020 Apr 27

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2015-02-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2016-05-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2017-08-10

Breast cancer research and treatment, 2011-10

J. Clin. Oncol., 2018 May 30

Cancer Treat Rev, 2013 Jun 10

Clin Cancer Res, 2019 Sep 12

J Clin Oncol, 2020 May 29

Cancer, 2000-03-15

Front Oncol, 2020 Dec 03

Annals of surgical oncology, 2018-07

J Clin Oncol, 2018 Aug 14

J Clin Oncol, 2020 Sep 16

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2009-12-01

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-07-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2014-07-10

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-09-10

Breast, 2011 Sep 08

Sci Rep, 2019 Dec 02

J Clin Oncol, 2021 Feb 04

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2018-09-20

Lancet Oncol., 2016-06-01

The Lancet. Oncology, 2019-04

J Natl Cancer Inst,

Lancet Oncol, 2021 May 04

Clin Cancer Res,

Clin Breast Cancer, 2020 Oct 06

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2019-10-10

JAMA Oncol,

Annals of oncology : official journal of the European Society for Medical Oncology, 2019-08-01

J Thorac Oncol, 2020 Jan 13

J Immunother Cancer, 2019 Jan 21

ESMO Open, 2021 Aug 31

Cancer, 2019 Jul 18

J Clin Oncol, 2021 Dec 10

The Lancet. Oncology, 2014-02

Front Oncol, 2018 Apr 17

Nature, 2021 Dec 15

N Engl J Med, 2022 Jan 19

Gynecol Oncol, 2020 Nov 05

Lancet, 2021 Jun 05

Lancet,

Br J Cancer, 2021 Jan 21

Clin Cancer Res, 2022 Jan 19

JCO Precis Oncol, 2019 Nov 15

JAMA Oncol,

Annals of surgical oncology, 2019-10

Sci Rep, 2022 Jan 20

The Lancet. Oncology, 2019-06

J Clin Oncol, 2020 Feb 14

N. Engl. J. Med., 2017 Jun 04

The New England journal of medicine, 2018-08-23

Breast Cancer Res Treat, 2016 Feb 18

Mol Cancer Ther, 2018 Mar 28

Eur J Cancer, 2014 Aug 12

N. Engl. J. Med.,