Spotlight from JADPRO Live 2023

Improving Outcomes for Patients With Metastatic HER2-Positive Breast Cancer

Rose DiMarco, PharmD, BCPS, BCOP, of the Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital, discusses a presentation that reviewed practice guideline updates for patients with metastatic HER2-overexpressing breast cancer, the increased clinical relevance of the new “HER2-low” category of HER2 expression, and best practices when monitoring and managing adverse events associated with novel HER2-targeted agents for advanced disease.


Rose DiMarco:

I just saw the presentation on improving outcomes in metastatic HER2 positive breast cancer, and I thought it was an amazing presentation. They had a panel and a discussion based on landmark trials such as the DESTINY-Breast03 and HER2CLIMB. There was a question and answer period. We talked about the implications for HER2 low expression in metastatic breast cancer, as well as new data for the X-7/7 trial, which looked at patients on capecitabine 7 days on and 7 off, which I thought was amazing because it is so complicated to treat patients with capecitabine. What I found most interesting about this presentation was the discussion on patients with brain mets, so not just newly diagnosed patients with brain mets, but also patients who develop metastasis during systemic therapies and how to manage and when to start new treatments. I also really enjoyed the conversation as well on the D-TORCH trial, which looked at topical diclofenac.

I actually want to read a little bit about that more myself because the implications for treating patients with capecitabine and hand-foot syndrome are so large that I'd like to see if there is a role for prevention of hand-foot syndrome in that patient population using diclofenac. I also really appreciated the discussion on interstitial lung disease. They went through diagnosing, treatment, and risk factors for patients developing ILD, especially on a HER2 low treatments, nausea in those ADCs as well. I overall really enjoyed this presentation. I learned so much, and I think there is a lot to learn for advanced practitioners as well as caregivers too, to help manage those side effects.

The presenters included really great figures, diagrams, and tables to help again, diagnose and treat interstitial lung disease. I'm definitely going to print that out, put that on the wall in clinic. Really appreciate them compiling the data for us, especially in terms of grading, which can be so complicated in these patients. I would love to share that with my care team as well, and I just really appreciate all the work they put into this presentation.

The panel consisted of a physician and two nurse practitioners, which I felt was very reflective of clinic, and it gave a great perspective between both sides of the care continuum, and I felt like the discussion was really informative for patients and helped me gather information for what I take back to clinic. I thought the slides were very well done. They were full of data and they gave highlights on very important clinical trials in the metastatic breast cancer setting. I look forward to printing them out and handing them out in clinic. The clinical pearls I learned in this presentation were again, the management and diagnosing of interstitial lung disease, nausea, hand- foot syndrome prevention, especially with the use of that topical diclofenac. That trial was in a small subset of patients, but could really be useful in clinic, and I just learned so much from their presentation.