HER2CLIMB Regimen Can Be Used Earlier in HER2+ Metastatic Breast Cancer

Nancy U. Lin, MD, associate professor of medicine at Harvard Medical School; associate chief of the Division of Breast Oncology at the Susan F. Smith Center for Women's Cancers; and director of the Metastatic Breast Cancer Program at the Dana-Farber Cancer Institute, discusses how she would use the HER2CLIMB regimen of tucatinib (Tukysa) plus trastuzumab (Herceptin) and capecitabine now that it has been approved for treatment of patients with HER2-positive metastatic breast cancer.

Patients had to be in their third line of treatment to be included in the HER2CLIMB trial, and that’s where Lin says she would use it in the clinic, instead of as a later-line regimen. She would move it up because of the potential benefits, including survival. The benefit with the triplet was seen in the overall population, not just patients with brain metastases.

This combination has a learning curve in terms of managing the toxicity profile, according to Lin. The adverse events were manageable in HER2CLIMB, and a lot of the toxicity came from what has been previously seen with capecitabine.

Most patients in this setting have already been exposed to trastuzumab by the time they enroll to the HER2CLIMB regimen. There can be some diarrhea and rash with tucatinib, but these events are less common than with other tyrosine kinase inhibitors, which target EGFR more strongly. Lin says there can be some increases in liver function blood tests that oncologists should monitor closely.

Overall, Lin thinks this regimen is manageable from a toxicity standpoint. The quality of life for patients while receiving this regimen can be good. There was a substudy in the HER2CLIMB trial, and those results will provide more information on how the triplet impacts patients.

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