Trastuzumab Deruxtecan in HER2-Low Breast Cancer: Who’s the Right Patient?

Sara Nunnery, MD, director of breast cancer research at Tennessee Oncology, outlines key considerations when deciding whether to offer trastuzumab deruxtecan to patients with HER2-low or HER2-ultralow metastatic breast cancer. Dr. Nunnery explains how clinical factors, treatment setting (IV vs oral), and patient preferences around quality of life all play a role in determining the ideal candidate for this therapy.

Transcript

Are there certain patient characteristics or biomarkers that make someone an especially good candidate for trastuzumab deruxtecan in HER2-low or -ultralow breast cancer?

Dr. Nunnery: That is such a great question. I think the big factors at play in deciding who is going to benefit or I should say who we should offer Enhertu to are a lot of clinical factors and also patient goals. This treatment is an IV treatment, which means patients now have to get a port. They now have to come to the infusion clinic for an IV therapy every three weeks. That can mean hair loss for patients and other side effects that people think about with chemotherapy. And so that can be a really big identity shift for patients.

And we realize that’s a big shift to go from having been taking oral therapies or maybe an injection once a month to now having to have a port and come in for infusions. Whereas the kind of first-line chemotherapy that a lot of us reach for is a drug called capecitabine, which is oral. And so some patients still very much prefer to use an oral therapy for as long as possible rather than go to an IV treatment, which is certainly not unreasonable.

So it’s a really important conversation for physicians to have with their patients about, you know, is, is staying on an oral therapy and those impacts on quality of life the priority or do we want to go ahead and go to the treatment that might have the best efficacy, even though it will affect our quality of life a little bit differently. So those are the really big factors to think about.