If your cancer is HER2 positive and you’ve already had one or more HER2-directed therapies for metastatic disease, then you’re eligible to receive the newly-approved combination of the oral drug Tukysa (Tucatinib) with Xeloda (capecitabine) and Herceptin (or an approved biosimilar).
FDA-approval for this combination was based upon the results of the HER2CLIMB study in which HER2 positive MBC patients, including patients with brain metastases (40% of which were untreated, or treated and progressing), were randomized to receive either the triplet of Tukysa (Tucatinib) in combination with Xeloda and Herceptin, or the doublet of Xeloda and Herceptin. The Overall Survival (OS) rate at 2 years was 44.9% for patients in the triplet arm vs. 26.6% in the doublet arm, and the median OS was 21.9 months vs. 17.4 months, respectively. Among patients with brain metastases, the Progression Free Survival (PFS) rate at 1 year was 24.9% in the triplet arm vs. 0% in the doublet arm, and the median PFS was 7.6 months vs. 5.4 months respectively. The overall and progression-free survival results were consistent across all prespecified subgroups based upon age, race, hormone receptor status, geographic location, and other factors. From: healio.com/hematology-oncol...
The above and similar information about approved MBC treatments and cutting edge research is in my book, “The Insider’s Guide to Metastatic Breast Cancer” which is also available as a complimentary .pdf. For information, please visit insidersguidembc.com/about
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I don't have that type of BC but did want to thank you for sharing such valuable information. I really appreciate that you included great/helpful data....
Take care,
Lynn
It’s good there is another possibility for some people. It mine is HER-
Sadly I believe it isn't approved in UK yet due to Brexit. I'm currently waiting to find out, after just being diagnosed with brain mets and I'm HER2 positive, whether a clinical trial finds me suitable. This would be kadcyla in use with tucatanib.
caslav, the notes below about treatment for HER2+ MBC in countries covered by NICE guidelines are from my book, "The Insider's Guide to Metastatic Breast Cancer." I hope this may be helpful!
GUIDELINES FOR HER2 POSITIVE, HORMONE RECEPTOR NEGATIVE MBC PATIENTS GOVERNED BY NICE
First-Line Therapy for HER2 Positive, Hormone Receptor Negative Patients Governed by NICE:
• The combination of Herceptin (or a biosimilar), Perjeta, and Taxotere is recommended for patients who have not had previous anti-HER2 therapy or chemotherapy for their metastatic disease.
• Herceptin (or a biosimilar) in combination with Taxol is recommended as an option for HER2+ patients who have not received chemotherapy for MBC and in whom anthracycline treatment is inappropriate.
Subsequent Therapies for HER2 Positive, Hormone Receptor Negative Patients Governed by NICE:
• Kadcyla is recommended as an option for patients who previously received Herceptin and a taxane, either separately or in combination.
• Enhertu (trastuzumab deruxtecan) has been granted conditional authorization in the UK as a monotherapy for the treatment of adult patients with unresectable or metastatic HER2 positive breast cancer who have received two or more prior anti-HER2 based regimens.
• Halaven is recommended as an option for MBC patients after they have progressed on at least 2 chemotherapy regimens (which may include an anthracycline or a taxane, and Xeloda).
• Herceptin (or a biosimilar) alone is recommended as an option for patients who have received at least two chemotherapy regimens for MBC. Prior chemotherapy must have included at least an anthracycline and a taxane where these treatments are appropriate.
• For patients who progressed on Herceptin, treatment with Herceptin should be changed to a different regimen unless the progression is solely in the brain or meninges, in which case Herceptin should be continued. From: pathways.nice.org.uk/pathwa...
Thank you for this information. I should have specified on my message that I'm also hormone positive. So triple positive and it's just come to my attention that there aren't as many treatment pathways in the UK ?
The same applies for triple positive MBC, and you also may have hormonal therapy options.
Thank you. I'm having to come off herceptin and perjeta infusions as recent CT scans also show slight progression in my liver since I had a stable scan in January. The brain MRI is the first I've had since being diagnosed with MBC last april. Either on a clinical trial (waiting to hear) or staying with current hospital and oncologist I will be having kadcyla and I'm staying on letrozole which I've been on 6 months now.
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