How are you deciding between T-DXd/pertuzumab and THP> HP/tucatinib in patients with metastatic HER2+ breast cancer?

I am reserving HP/tucatinib to the maintenance setting (after 1L THP, as was studied in HER2CLIMB-05, but also will plan to offer it as maintenance after 1L T-DXd/P in patients who experience cumulative toxicity on T-DXd/P and need to stop). I would tend to offer HP/tucatinib maintenance to those wi...

Tucatinib is probably a little better for brain mets, although certainly T-DXd can treat brain mets. If a patient relapses in the brain while getting HP, then the value of HP continuation is likely to be low.