What are the preferred regimens for the treatment of HER2/neu-positive metastatic breast cancer in women with previous exposure to trastuzumab?

Updated: Apr 23, 2020
  • Author: Joseph A Sparano, MD; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

Answer

Regimens are as follows:

  • Capecitabine 1000 mg/m2 PO BID on days 1-14 plus  lapatinib 1250 mg PO on days 1-21 every 3 wk or

  • Trastuzumab 4 mg/kg IV on day 1 followed by 2 mg/kg IV weekly or  8 mg/kg IV on day 1 followed by 6 mg/kg every 3 wk plus  other first-line agents or

  • Trastuzumab 4 mg/kg IV on day 1 followed by 2 mg/kg IV weekly or  8 mg/kg IV on day 1 followed by 6 mg/kg every 3 wk plus  capecitabine 2500 mg/m² on days 1-14 every 3 wk [38, 42] or

  • Trastuzumab 4 mg/kg IV on day 1 followed by 2 mg/kg IV weekly or  8 mg/kg IV on day 1 followed by 6 mg/kg every 3 wk plus  lapatinib 1000 mg PO daily or

  • Ado-trastuzumab: 3.6 mg/kg IV infusion q3 wk as a single agent in patients who previously received trastuzumab and a taxane, either separately or in combination [43]

  • Trastuzumab deruxtecan: 5.4 mg/kg IV q3 wk as a single agent for unresectable or metastatic HER2-positive breast cancer in adults who have received 2 or more prior anti-HER2-based regimens in the metastatic setting [44]  

  • Trastuzumab 8 mg/kg IV on day 1 followed by 6 mg/kg every 3 wk plus  capecitabine 1000 mg/m2 on days 1-14 every 3 wk plus  tucatinib 300 mg PO BID [45]


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