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Navigating HER2+ Breast Cancer Treatment: Expert Perspectives on Patient Selection and Treatment Sequencing

home / around-the-practice / navigating-her2-breast-cancer-treatment-expert-perspectives-on-patient-selection-and-treatment

Panelists highlighted evolving personalized treatment strategies in HER2-positive metastatic breast cancer—spanning maintenance therapy innovations, frontline and later-line sequencing with agents like trastuzumab deruxtecan and tucatinib, management of CNS metastases and toxicities such as interstitial lung disease, and the critical role of multidisciplinary care and clinical trials in optimizing patient outcomes and quality of life throughout complex, prolonged disease courses.

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Current Treatment Approaches in HER2+ Metastatic Breast Cancer

EP. 1: Current Treatment Approaches in HER2+ Metastatic Breast Cancer

Heather McArthur, MD, MPH;Ruta Rao, MD;Gregory Vidal, MD, PhD
June 17th 2025

Panelists discussed how evolving strategies in HER2-positive metastatic breast cancer are shifting toward more personalized maintenance approaches, including the integration of CDK4/6 inhibitors and endocrine therapy, with growing interest in chemotherapy-free options for select patients.


Optimizing Maintenance Therapy After First-Line Treatment in HER2+ Metastatic Breast Cancer

EP. 2: Optimizing Maintenance Therapy After First-Line Treatment in HER2+ Metastatic Breast Cancer

Heather McArthur, MD, MPH;Ruta Rao, MD;Gregory Vidal, MD, PhD
June 17th 2025

Panelists discussed how maintenance therapy in HER2-positive metastatic breast cancer is evolving beyond traditional dual antibody approaches, with emerging strategies incorporating targeted agents like tucatinib and endocrine therapy to personalize care and potentially delay central nervous system progression.


The Evolving Role of T-DXd in HER2+ Metastatic Breast Cancer

EP. 3: The Evolving Role of T-DXd in HER2+ Metastatic Breast Cancer

Heather McArthur, MD, MPH;Ruta Rao, MD;Gregory Vidal, MD, PhD
June 24th 2025

Panelists discussed how DESTINY-Breast03 firmly established trastuzumab deruxtecan (T-DXd) as the second-line standard in HER2-positive metastatic breast cancer, while early DESTINY-Breast09 data suggest that T-DXd combined with pertuzumab may challenge the CLEOPATRA regimen in the frontline setting, though questions remain about global applicability.


Strategies for Monitoring and Managing T-DXd-Related Adverse Effects

EP. 4: Strategies for Monitoring and Managing T-DXd-Related Adverse Effects

Heather McArthur, MD, MPH;Ruta Rao, MD;Gregory Vidal, MD, PhD
June 24th 2025

Panelists discussed the persistent risk of interstitial lung disease with trastuzumab deruxtecan, emphasizing the need for early detection through routine imaging, rapid intervention to prevent severe toxicity, and cautious retreatment in select cases where interstitial lung disease was mild and well managed.


Patient Case Presentation: A 47-Year-Old Woman With HER2+ mBC and CNS Progression

EP. 5: Patient Case Presentation: A 47-Year-Old Woman With HER2+ mBC and CNS Progression

Heather McArthur, MD, MPH;Ruta Rao, MD;Gregory Vidal, MD, PhD
July 1st 2025

Panelists discussed a complex case of a 47-year-old woman with metastatic HER2-positive breast cancer, emphasizing the importance of continuous systemic therapy despite treatment interruptions, the critical role of multidisciplinary care for central nervous system involvement, and the need to balance efficacy with quality of life as patients navigate prolonged disease courses and evolving treatment strategies.


Strategic Sequencing in HER2+ Breast Cancer: Optimizing Treatment in the Third Line and Beyond

EP. 6: Strategic Sequencing in HER2+ Breast Cancer: Optimizing Treatment in the Third Line and Beyond

Heather McArthur, MD, MPH;Ruta Rao, MD;Gregory Vidal, MD, PhD
July 1st 2025

Panelists emphasized that for a patient with metastatic HER2-positive breast cancer and active brain metastases, selecting a treatment with proven intracranial activity is critical, while carefully considering prior therapy tolerability, radiation history, and the balance between treatment efficacy and patient convenience to optimize both disease control and quality of life.


Tucatinib Triplet Therapy: Efficacy, Safety and Clinical Decision-Making

EP. 7: Tucatinib Triplet Therapy: Efficacy, Safety and Clinical Decision-Making

Heather McArthur, MD, MPH;Ruta Rao, MD;Gregory Vidal, MD, PhD
July 8th 2025

Panelists highlighted that the HER2CLIMB study showed adding tucatinib to trastuzumab and capecitabine provides a meaningful progression-free survival benefit in HER2-positive metastatic breast cancer with brain metastases, balancing improved intracranial control against manageable toxicities like diarrhea and hand-foot syndrome, and underscored the importance of patient education and dose management to maintain adherence and quality of life.


Expert Insights: Later-Line Treatment Strategies for HER2+ Metastatic Breast Cancer

EP. 8: Expert Insights: Later-Line Treatment Strategies for HER2+ Metastatic Breast Cancer

Heather McArthur, MD, MPH;Ruta Rao, MD;Gregory Vidal, MD, PhD
July 8th 2025

Panelists agreed that beyond third-line therapy for HER2-positive metastatic breast cancer, treatment becomes highly individualized—often described as the “wild West”—with options including various monoclonal antibodies, tyrosine kinase inhibitors, chemotherapy, and emerging agents; decisions are largely based on prior toxicities, patient preferences, and disease biology, with clinical trials playing a crucial role in offering promising new therapies that may outperform standard care.


Looking Ahead in HER2+ mBC: Unmet Needs, Future Perspectives and Highlights From ASCO 2025

EP. 9: Looking Ahead in HER2+ mBC: Unmet Needs, Future Perspectives and Highlights From ASCO 2025

Heather McArthur, MD, MPH;Ruta Rao, MD;Gregory Vidal, MD, PhD
July 8th 2025

Panelists highlighted the impressive central nervous system activity of trastuzumab deruxtecan demonstrated in the DX12 trial, underscoring the need for multidisciplinary collaboration to optimize treatment of brain metastases and reduce reliance on whole-brain radiation, while acknowledging ongoing challenges in sequencing and patient selection amid evolving therapies.

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