In this article
Two new emerging treatment options for metastatic HER2-positive breast cancer have shown very encouraging results from recent clinical trials. HER2-positive breast cancer is a type of metastatic breast cancer that overproduces the HER2 protein, and both trials evaluated drugs in women who had already received prior treatment for this disease. The results were presented at the San Antonio Breast Cancer Symposium (SABCS) in December 2019 and published in the New England Journal of Medicine.
In the HER2CLIMB trial, women treated with tucatinib in addition to trastuzumab and capecitabine lived longer than women who received only trastuzumab and capecitabine. Notably, this benefit extended to women whose cancer had spread to the brain — a particularly challenging group that is frequently excluded from breast cancer trials, making this finding especially significant. Based on these results, using tucatinib with trastuzumab and capecitabine together is considered a strong treatment approach for women with HER2-positive breast cancer, including those with brain metastases.
Trastuzumab deruxtecan (Enhertu) was evaluated in the smaller DESTINY-Breast01 trial without direct comparison to another treatment. Despite this, many women who received the drug saw their tumors shrink and experienced an extended period without disease progression — results that have generated significant interest in the oncology community.
However, both tucatinib and trastuzumab deruxtecan have been associated with severe side effects, and trastuzumab deruxtecan in particular has been linked to a notable risk of lung infections, including cases that have led to patient deaths. The FDA's approval of trastuzumab deruxtecan therefore comes with a specific warning about lung-related infections called interstitial lung disease (ILD). As a result, while these two regimens represent meaningful advances for metastatic HER2-positive breast cancer — particularly for patients with brain metastases — further studies and careful clinical management are required before they can be considered part of a universal treatment protocol.
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About Alysha Mendossa
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This article is for educational purposes only and should not replace medical advice, diagnosis, or treatment from a qualified oncology specialist. Every patient's case is different. Treatment decisions should always be made after a review of complete medical records by the treating medical team.
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