Oncology Brothers: Practice-Changing Cancer Discussions Clinical Implications of Testing HER2 and Targeted Therapies Approved - Dr. Komal Jhaveri
Dec 19, 2025
Dr. Komal Jhaveri, a breast medical oncologist at Memorial Sloan Kettering, shares her expertise on the significance of HER2 testing in metastatic hormone receptor positive breast cancer. She discusses groundbreaking findings from the DESTINY Breast-04 and -06 studies, exploring low and ultra-low HER2 expressions, and the implications for treatment options. Dr. Jhaveri highlights the importance of antibody-drug conjugates like T-DXd, while addressing management strategies for treatment-related toxicities, making this a must-listen for healthcare professionals.
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HER2 As A Therapeutic Delivery Target
- HER2 can serve as a delivery target rather than only an oncogenic driver for ADCs like trastuzumab deruxtecan.
- Destiny Breast‑04 and ‑06 show benefit even at low and ultra‑low HER2 levels in metastatic settings.
Rebiopsy If HER2 Is True Zero
- Test HER2 on available tissue and do not withhold TDXd if any HER2 expression is present.
- If you see a consistent true IHC zero, consider rebiopsy when appropriate to reassess HER2.
Majority Of Tumors Show Some HER2
- HER2 low plus ultra‑low together cover about 85–90% of breast cancers, leaving 10–15% truly HER2 null.
- Most reports now incorporate ultra‑low into standard pathology reporting to reduce uncertainty.