Do You Have HER2-Positive Metastatic Breast Cancer? Here’s A Breakdown Of Some Of Your Treatment Options
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/ Updated February 23rd, 2023

Do You Have HER2-Positive Metastatic Breast Cancer? Here’s A Breakdown Of Some Of Your Treatment Options

Medical Source: Dr. Elizabeth Comen
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Exploring Your Treatment Options

  • Therapies that specifically target the HER2 receptor are available.
  • Some of these therapies are used in the "front line" while others serve as a "back up" option.
  • One drug is able to cross the "blood brain barrier" and has helped patients with brain metastasis.
  • A newer drug that’s approved for both HER2-positive and HER2-low metastatic breast cancer called Enhertu is also another option to ask your doctor about.
  • Overall, women with this type of cancer now have several treatment options.
If you are diagnosed with HER2-positive breast cancer it means you likely have high levels of the HER2 protein on the outside of your cancer cells. Having metastatic HER2 positive breast cancer means that not only is the HER2 receptor present on the outside of the cell, but that the cancer has spread beyond the breast.

"So that means that the breast cancer is living in another part of your body," says Dr. Elizabeth Comen, a medical oncologist from the Memorial Sloan Cancer Center in New York. She goes on to explain "That can be in the liver, the bone, the lungs or potentially even the brain."

Therapies that Target the Receptor

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Targeted therapy is a treatment that targets specific genes, proteins, or the tissue environment that contribute to the cancer's development and growth. There are specific targeted therapies meant to treat HER2 positive cancers, that are used in metastatic breast cancer. "The good news is that there are a lot of new treatments available that target the HER2 receptor," says Dr. Comen.

RELATED: Are You A Metastatic Breast Cancer Patient Curious About The Drug Enhertu? Here's What You Need To Know

These include Herceptin and pertuzumab, which can be used together with chemotherapy and are usually used as front line treatments. That means it will be the first treatment you receive, says Dr. Comen.

Another drug that used is T-DM1, which is used if you have already been treated with Herceptin. Another drug available is called Tucatinib, and it can be used for women who have not responded to Herceptin or pertuzumab.

Crossing the Blood-Brain Barrier

Tucatinib can be used for women who may have had their disease get worse after receiving Herceptin, Pertuzumab, or T-DM1.

"The important thing to know about Tucatiniband that's really excitingis that it has been shown to have some benefit for patients with brain metastasis," says Dr. Comen.

The current medications used to treat HER2 positive breast cancer do a good job of controlling the disease below what's known as the "the blood-brain barrier." But this barrier prevents many drugs from reaching the brain, making it difficult to control brain metastasis. Instead, surgery and radiation therapy have traditionally been used to treat brain metastasis when it occurs.

"It is really exciting to have newer drugs on the market that can penetrate the brain and improve outcomes for patients with brain metastasis," says Dr. Comen.

However, despite the potential for newer drugs to cross the blood-brain barrier, in patients with known brain metastasis it is still important to be evaluated by a surgeon and radiation oncologist to help with treatment recommendations.

A Newer Option

The drug Enhertu is another great option for metastatic breast cancer patients. It can be used in patients with HER2-positive and HER2-low metastatic breast cancer.

In fact, the results of an Enhertu breast cancer study published earlier this year grabbed many a national headline, with some oncologists even calling the findings "groundbreaking." The study, which was published in The New England Journal of Medicine in March, found that the experimental drug trastuzumab deruxtecan (brand name: Enhertu), "resulted in significantly longer progression-free and overall survival than the physician's choice of chemotherapy" for patients with metastatic breast cancer.

"The reason why it (the study) got so much attention is because of the improvement in overall survival," Dr. Comen, said in a separate interview with SurvivorNet. "Which is hard to do in metastatic breast cancer patients."

If you have HER2-low or HER2-positive metastatic breast cancer, consider asking your doctor if Enhertu is right for you.

Learn more about SurvivorNet's rigorous medical review process.

Dr. Elizabeth Comen serves as a medical advisor to SurvivorNet. She is a medical oncologist at Memorial Sloan Kettering Cancer Center. Read More

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