“Positioning of tucatinib in the new clinical scenario of HER2-positive metastatic breast cancer: An Italian and Spanish consensus paper”
Pierfranco Conte,
Eva Ciruelos,
Giuseppe Curigliano,
Michelino De Laurentiis,
Lucia Del Mastro,
Alessandra Gennari,
Antonio Llombart,
Miguel Martìn,
Francesca Poggio,
Aleix Prat,
Fabio Puglisi,
Cristina Saura
Affiliations
Pierfranco Conte
San Camillo Hospital IRCCS, Venezia, Italy
Eva Ciruelos
Hospital Universitario 12 de Octubre, Madrid, Spain; Centro Integral Oncológico Clara Campal HM (CIOCC), Madrid, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain
Giuseppe Curigliano
Division of Early Drug Development for Innovative Therapy, European Institute of Oncology (IEO), IRCCS, Milan, Italy; Department of Oncology and Haematology, University of Milano, Milano, Italy
Michelino De Laurentiis
National Cancer Institute, IRCCS Fondazione G. Pascale, Napoli, Italy
Lucia Del Mastro
Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
Alessandra Gennari
Medical Oncology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
Antonio Llombart
Oncology Department, Hospital Arnau de Vilanova, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain; Oncology Department, Universidad Católica, Valencia 46900 Spain
Miguel Martìn
Gregorio Marañon Health Research Institute, Universidad Complutense, Madrid, Spain
Francesca Poggio
Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Corresponding author
Aleix Prat
Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Department of Medical Oncology, Hospital Clinic of Barcelona, Spain; SOLTI Cooperative Group, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain; Institute of Oncology (IOB)-Hospital Quirónsalud, Barcelona, Spain
Fabio Puglisi
Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano (PN), Italy
Cristina Saura
Medical Oncology Service, Breast Cancer Unit, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
Introduction: Advancements in monoclonal antibodies, tyrosine kinase inhibitors, and antibody drug conjugates (ADCs) have notably enhanced outcomes for metastatic HER2-positive breast cancer patients. Despite the expanding treatment options and clinical complexities, determining the optimal sequence of HER2-targeted therapies remains partly uncertain, influenced by various factors. Methods: To refine HER2-positive metastatic breast cancer management, particularly regarding tucatinib's position, a Steering Committee of leading oncologists in breast cancer care devised a panel of statements via a Delphi approach, focusing on five key topics: general clinical management, therapeutic approaches for patients with HER2-positive breast cancer and brain metastases, treatment sequence, and tucatinib's safety and efficacy. Results: A total of 29 statements were deliberated, with strong consensus achieved for most. However, no consensus emerged regarding the management of brain progression alongside stable extracranial disease: 48 % advocated for switching to tucatinib, while 53 % favored a stereotactic brain radiotherapy (SBRT) approach if feasible. Conclusion: The unanimous consensus attained in this Delphi panel, particularly regarding tucatinib's efficacy and safety, underscores oncologists' recognition of its clinical significance based on existing trial data. These findings align closely with current literature, shedding light on areas necessitating further investigation, not thoroughly explored in prior studies. Moreover, the results underscore the scarcity of data on managing brain progression alongside stable extracranial disease, emphasizing the imperative for dedicated research to address these gaps and yield definitive insights.
