Ep. 48 HER2-Positive Metastatic Breast Cancer: Treatment Insights & Protocols with Dr. Erika Hamilton

In a patient with metastatic HER2-positive breast cancer, what should guide the next decision: trial data, toxicity, or durability of response? In this episode of BackTable Tumor Board, Dr. Lindsay Peterson (Washington University) sits down with Dr. Erica Hamilton (Sarah Cannon Research Institute) to examine how next-generation HER2-directed therapies are reshaping the management of metastatic disease. As treatment options expand beyond trastuzumab-based regimens to agents such as trastuzumab deruxtecan and tucatinib, clinical decision-making increasingly hinges on sequencing strategy, interpretation of evolving trial data, and thoughtful toxicity management.

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SYNPOSIS

The discussion integrates findings from pivotal studies including DESTINY-Breast09 and PATINA, highlighting how these data influence frontline and maintenance approaches. Dr. Hamilton outlines practical considerations in balancing depth and durability of response with quality-of-life concerns, and how she approaches therapy transitions in real-world practice. The episode also explores the management of CNS involvement within the broader systemic treatment landscape and considers whether current advances meaningfully shift long-term outcomes for patients with HER2-positive metastatic breast cancer.

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TIMESTAMPS

00:00 - Introduction
01:16 - Metastatic HER2-Positive Breast Cancer
06:46 - Treatment Strategies and Patient Management
11:57 - Maintenance Therapy Options
16:28 - HER2-Positive Breast Cancer Trials
20:13 - Brain Metastases and Systemic Therapy
27:38 - Future Directions in HER2-Positive Breast Cancer

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RESOURCES

DESTINY-Breast09 Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa2508668

PATINA Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa2511218

HER2CLIMB Trial
https://www.nejm.org/doi/full/10.1056/NEJMoa1914609