Dr. Rao on Incorporating Updated NCCN Guidelines into Treatment Selection for HER2+ Breast Cancer

Ruta D. Rao, MD, discusses how updated guidelines from the National Comprehensive Cancer Network have influenced treatment choice for patients with HER2-positive breast cancer.

Ruta D. Rao, MD, Associate Professor, Department of Internal Medicine, Division of Hematology, Oncology, and Cell Therapy, Rush Medical College, Director, Coleman Foundation Comprehensive Breast Cancer Clinic, Medical Director, Rush University Cancer Center, explains how the updated National Comprehensive Cancer Network (NCCN) guidelines have influenced treatment choice for patients with HER2-positive breast cancer.

NCCN guidelines now recommend fam-trastuzumab deruxtecan-nxki (Enhertu) as a second-line treatment option for patients with HER2-positive metastatic breast cancer, Rao says. Although ado-trastuzumab emtansine (T-DM1; Kadcyla) is also a recommended second-line agent, trastuzumab deruxtecan is on the list of preferred regimens. These guidelines support the selection of trastuzumab deruxtecan over T-DM1 in this patient population, Rao says.

Additionally, the guidelines list several treatment regimens as recommended third-line treatment options, including the combination of trastuzumab (Herceptin), capecitabine (Xeloda), and tucatinib (Tukysa). Other HER2-directed agents such as neratinib (Nerlynx), margintuximab-cmkb (Margenza), and trastuzumab in combination with chemotherapy are also recommended for patients with metastatic HER2-positive disease requiring third-line therapy , concludes Rao.

Martin E. Berry