The American Society of Clinical Oncology (ASCO) has released updated recommendations for systemic therapy for advanced HER2-positive breast cancer. The main changes affected the second and third lines of therapy.
ASCO has updated recommendations for systemic therapy for advanced HER2-positive breast cancer. The previous version of the guide was dated 2018.
The first line of therapy remained unchanged. The standard of care for advanced HER2-positive breast cancer remains the combination of trastuzumab, pertuzumab, and taxanes. Taxanes are contraindicated in patients with congestive heart failure and significant changes in left ventricular ejection fraction.
If disease progression is detected during or after the end of the first line of therapy, experts recommend prescribing trastuzumab deruxtecan as a second line.
As third-line therapy, trastuzumab emtansine or a combination of tucatinib, trastuzumab and capecitabine can be prescribed. You can also use the combination of neratinib with capecitabine, the combination of lapatinib and trastuzumab, lapatinib and capecitabine, or other chemotherapy combinations with trastuzumab. It is possible to prescribe margetuximab in combination with chemotherapy. If the tumor is positive for estrogen and/or progesterone receptors, patients can be offered hormonal therapy. It is possible to prescribe abemaciclib with trastuzumab and fulvestrant.
No advantages of any mode over others have been identified.
Experts emphasize that although a doctor can discuss hormone therapy with a patient, most women are treated with chemotherapy in combination with HER2-targeted therapy.