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HER2+ Metastatic Breast Cancer: Sequencing & Shared Decision-Making

Medical oncology

Metastatic Breast Cancer

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Description

This program is supported by an independent education grant from Pfizer Global Medical Grants. This online education program has been designed for healthcare professionals globally.

Prefer to read instead? Read our Key Clinical Summary here.

In this 45-minute on-demand session, leading expert Sarah Sammons, MD examines multi-drug maintenance strategies, patient-centred decision-making in HER2+ metastatic breast cancer, and the integration of guidelines and emerging evidence into clinical practice. Dr. Sammons will evaluate the role of TKIs and ADCs in maintenance, discuss sequencing approaches across lines of therapy, and illustrate how to tailor regimens based on tumour biology, CNS risk, comorbidities, and patient preferences.

Accreditation: 0.5 AMA PRA Category 1 Credits™

This is a rapidly evolving field: Don't forget to read out latest update summary from San Antonio Breast Cancer Symposium 2025 >

Session Highlights

Multi-Drug Maintenance Strategies: Evaluate evidence for adding TKIs or switching/layering ADCs, balancing efficacy, CNS activity, and toxicity profiles.
Sequencing Approaches: Determine optimal ordering of TKIs, ADCs, and HER2-targeted agents across the treatment continuum.
Practical Dosing & Management: Apply guidance for dose modifications, toxicity mitigation, and therapy adaptation.
Patient-Centred Decision-Making: Use shared-decision tools to match treatment intensity to disease tempo, patient goals, and survivorship priorities.
Guidelines & Evidence Integration: Align clinical decision-making with current consensus recommendations while incorporating emerging trial results.

Who Should Watch

Medical Oncologists, Nurse Practitioners, Physician Assistants, Oncology Nurses, Oncology Fellows, Pharmacists, Internal Medicine Physicians with an oncology focus, and other HCPs involved in metastatic breast cancer care.

Presented by

Sarah Sammons, MD – Medical oncologist specializing in breast cancer, with a focus on metastatic disease and brain metastases. She has led clinical trials advancing treatment options for metastatic breast cancer. Formerly Associate Director of Breast Cancer Research at Duke Cancer Institute, Dr. Sammons has served since 2022 as a medical oncologist and Associate Director of the Metastatic Breast Cancer Program at Brigham and Women’s and Dana-Farber.

Disclosures

Dr Sarah Sammons has disclosed financial relationships within the past 24 months with the following ineligible companies: Daiichi Sankyo, Relay Therapeutics, Seagen, Sermonix, AstraZeneca, Gilead, Eli Lilly, Incyclix, Pfizer, and Novartis. These relationships include research funding and consulting/advisory roles.

These disclosures are made in accordance with ACCME standards to ensure transparency and objectivity in continuing education. Dr Sammons intends to discuss non-FDA uses of drug products and/or devices only in relation to products for which she has no financial relationships. She will disclose to the audience when this discussion takes place.

AffinityCE staff, MedAll staff, and all planners and reviewers have no relevant financial relationships with ineligible companies to disclose.

Activity Accreditation for Health Professions

This activity will be planned and implemented in accordance with the accreditation requirements and policies of both the Accreditation Council for Continuing Medical Education (ACCME) and the European Board for Accreditation of Continuing Education for Health Professionals (EBAC). Through joint providership with AffinityCE (ACCME-accredited) and MedAll (EBAC-accredited), continuing education credit will be provided for both live and enduring activities.

EBAC Compliance and Credit Conversion

This activity has been planned and implemented in accordance with the accreditation requirements and policies of EBAC.

In compliance with EBAC guidelines, all speakers and chairpersons participating in this programme have disclosed or indicated potential conflicts of interest which might cause a bias in the presentations. The Organizing Committee/Course Director is responsible for ensuring that all potential conflicts of interest relevant to the event are declared to the audience prior to the CE activities.

Through an agreement between EBAC and the American Medical Association, physicians may convert EBAC External CME credits to AMA PRA Category 0.75 Credits™. Information on the process to convert EBAC credit to AMA credit can be found on the AMA website at https://edhub.ama-assn.org/pages/applications. Other healthcare professionals may obtain from the AMA a certificate of having participated in an activity eligible for conversion of credit to AMA PRA Category 0.75 Credit™.

The Accreditation Council for Continuing Medical Education (ACCME) and the Royal College of Physicians and Surgeons of Canada hold an agreement on substantial equivalency of accreditation systems with EBAC.

How to Earn Your CME Credit

In order to obtain your CME credit and receive your certificate, please join the webinar and complete the assessment at the end. You will receive a link to your certificate automatically after completing the assessment.

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ACCME Continuing Education Information

Commercial support: This activity received monetary support through an independent education grant from Pfizer

This continuing education activity will be provided by AffinityCE and MedAll. This activity will provide continuing education credit for physicians. A statement of participation is available to other attendees.

AffinityCE staff, MedAll staff, as well as planners and reviewers, have no relevant financial relationships with ineligible companies to disclose. All disclosures from faculty will be presented prior to commencing the event.

Mitigation of Relevant Financial Relationships

AffinityCE adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education. Any individuals in a position to control the content of a CME activity, including faculty, planners, reviewers, or others, are required to disclose all relevant financial relationships with ineligible companies. Relevant financial relationships were mitigated by the peer review of content by non-conflicted reviewers prior to the commencement of the program.

Activity Accreditation for Health Professions

Physicians

This activity will be planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and Medall. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring activity a maximum of 0.5 AMA PRA Category 1 Credits™.

Physician Assistants

This activity will be planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring activity a maximum of 0.5 AMA PRA Category 1 Credits™. Physician assistants should claim only the credit commensurate with the extent of their participation in the activity.

Nurse Practitioners

This activity will be planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AffinityCE and MedAll. AffinityCE is accredited by the ACCME to provide continuing medical education for physicians.

AffinityCE designates this enduring activity a maximum of 0.5 AMA PRA Category 1 Credits™. Nurse practitioners should claim only the credit commensurate with the extent of their participation in the activity.

Nurses & Other Professionals

All other health care professionals completing this continuing education activity will be issued a statement of participation indicating the number of hours of continuing education credit. This may be used for professional education CE credit. Please consult your accrediting organization or licensing board for their acceptance of this CE activity.

Unapproved and/or off-label use disclosure

AffinityCE/MedAll requires CE faculty to disclose to the participants:

1. When products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not US Food and Drug Administration [FDA] approved); and

2. Any limitations on the information presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion.

Participation Costs

There is no cost to participate in this program.

Pharmacists

Pharmacists AffinityCE is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education (CPE).

Optimizing Maintenance in HER2+ Metastatic Breast Cancer - Enduring

Format: Enduring Portion

UAN: 0829-9999-25-171-H01-PCEUs: 0.5

No cost to participate.

Participant CE records will be electronically communicated to CPE Monitor.

Pharmacist Learning Objectives

At the conclusion of this web conference, participants should be able to:

Evaluate multi-drug maintenance strategies including TKIs and ADCs
Apply patient-centred, QoL-focused decision-making to personalize maintenance regimens.
Evaluate guidelines and latest evidence to understand the treatment paradigm and 1-L standard of care evolution for patients with HER2+ MBC

System Requirements

Mobile device (e.g., large-format smart phone; laptop or tablet computer) or desktop computer with a video display of at least 1024 × 768 pixels at 24-bit color depth, capable of connecting to the Internet at broadband or faster speeds, with a current version Internet browser and popular document viewing software (e.g., Microsoft Office, PDF viewer, image viewer) installed. Support for streaming or downloadable audio-visual materials (e.g., streaming MP4, MP3 audio) in hardware and software may be required to view, review, or participate in portions of the program

Supporting media

Learning objectives

Evaluate multi-drug maintenance strategies including TKIs and ADCs:

Evaluate the latest evidence for adding TKIs or switching/layering ADCs.
Balance efficacy endpoints, CNS benefits, and toxicity profiles when choosing TKIs vs ADCs.
Sequence and dose-modify multi-drug regimens.

Apply patient-centred, QoL-focused decision-making to personalize maintenance regimens:

Match regimen intensity to tumour biology, disease tempo and CNS risk.
Adjust doses, schedules, or drug combinations to mitigate toxicity and align with patient goals.
Use shared-decision tools to accommodate comorbidities, lifestyle, and survivorship priorities.

Evaluate guidelines and latest evidence to understand the treatment paradigm and 1-L standard of care evolution for patients with HER2+ MBC

Synthesize current guideline recommendations and ongoing studies.
Map decision points from induction through maintenance and later-line transitions.

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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Hello, my name is Doctor Sarah Salmons from Dana-Farber Cancer Institute in Boston, Massachusetts. And I am thrilled to be here at the Medal Grand Rounds to discuss optimizing therapy in HER2 positive metastatic breast cancer with a particular focus on the evolving landscape of the first line. These are my disclosures. The learning objectives today are to evaluate the guidelines and latest evidence to understand the treatment paradigm and the shifting treatment paradigm of first-line standard of care evolution for patients with HER2 positive metastatic breast cancer. We will also evaluate multi-drug maintenance strategies, including CDK46 inhibitors, and then we will also focus on applying patient-centered quality of life focused decision making to personalized maintenance regimens. For case one, we will evaluate the latest evidence to understand the treatment paradigm and first-line standard of care evolution in HER2 positive metastatic breast cancer, synthesizing current guideline recommendations and topline recent results. We will also map decision points from induction through maintenance and later line transitions. So for case one, First, we have a 45-year-old female with a past medical history of stage 3 estrogen receptor negative, HER2 positive breast cancer. She presented in 2024 with a T3N2 estrogen negative HER2 positive breast cancer and received TCHPx 6 neoadjuvantly. She then underwent lumpectomy and axillary lymph node dissection, showing RCV2 disease. So she had a fair amount of residual disease. She then completed one year of radiation, and also one year of adjuvant TDM one. Unfortunately, in September, the following year, so about 18 months after she completed TDM1, she presented with headaches. MRI revealed 3 brain metastases. PET CT scan was performed to evaluate her extracranial disease, which showed PET avid hilar lymphadenopathy. Biopsy of her hilar lymphadenopathy revealed a metastatic recurrence of her estrogen receptor negative HER2 positive disease. She went on to receive stereotactic radiosurgery to her 3 brain lesions. What is the best systemic therapy choice for her now that her radiation to her brain is over? Trastuzumab, duroxican with or without pertuzumab, docetaxel, trastuzumab, pertuzumab. Trastuzumab, pertuzumab, plus tatib. Trastuzumab mtansine or trastuzumab alone. Thank you so much for your answers. It's certainly an, an evolving landscape. Doctor Salmonds, thank you for presenting that case. Could you briefly summarize the key findings from Destiny Breast 09 that compared uh TDXD plus pertuzumab to the standard THP regimen in this exact first line setting. Yes, absolutely. So after more than a decade of having the same standard of care, Uh, we recently presented at ASCO 2025, had a new positive study that could be, is likely going to be practice changing in the first line for metastatic HER2 positive breast cancer. Destiny Breast 09 was a phase 3 international multi-center randomized trial that evaluated. Prastuzumab, duroxican plus pertuzumab, trastuzumab duroxican alone, or the previous standard of care, which was the Cleopatra regimen, which is a taxane plus pertuzumab and trastuzumab in patients with first line HER2 positive metastatic breast cancer. About half of the patients had de novo metastatic disease, and about 50% of the patients had recurrent disease. There was a mix of estrogen positive or estrogen negative patients. Patients were allowed to have stable brain metastasis at baseline. And what we saw was a striking improvement in progression-free survival, with TDXD plus pertuzumab versus the previous Cleopatra regimen or Taxane HP. The progression-free survival with TDXD plus pertuzumab was around 40 months versus around 28 months with the control. We have yet to see um overall survival from this regimen, but other endpoints including overall response rate, complete response rate, um, were also improved with trastuzumab, droxicam, plus pertuzumab. In the forest plot of the subgroups, we saw that pretty much all patients had benefit um from trastuzumab, droxicam plus pertuzumab versus the old standard. Um, including patients with a history of brain metastasis has a pretty striking benefit, um, with TDXD plus pertuzumab. Um, Patients with the PICC3CA mutation had benefit, regardless of estrogen status, regardless of visceral disease de novo versus recurrent. The TDXD plus pertuzumab population did quite well versus the previous THP standard. Given this dramatic improvement in progression free survival, should TDXD plus pertuzumab now be considered the new standard of care for this patient? That's a really good question. So we're currently in a setting of limbo. Um, the results of dusty breast 09 have been presented. Um, but regulatory authorities have not fully approved prastuzumab, duroxicam, plus pertuzumab in the first line setting yet. I think we are all pretty optimistic that they will in the near future, but at least right now. It's not quite approved. What we do have approved is PDXD is, you know, was previously approved in the second line setting. Um, based on the results of the Destiny Breast 03 clinical trial versus TDM1, and TDXD, at least in the US, is approved for patients who have relapsed within 12 months of their adjuvant therapy. This patient was just over 12 months since her adjuvant therapy. She doesn't quite meet that criteria, but I certainly would be thinking about TDXD for this patient in the first line for a couple of reasons. One is she has had relapse, you know, in pretty short, um, succession, um, after she already had taxane trastuzumab, pertuzumab, and a year of TDM1 or about a year later, and she now has new brain metastases and hilar lymph node involvement. So this is someone that I would definitely want to be thinking about trastuzumab, droican for if I had regulatory approval. If we're talking about pure sort of guideline driven, she's technically out of that 12 month, um, she's technically out of that 12 month range of relapse, and we do not yet have regulatory approval for Destiny Breast 009. So, re-challenging her with the Taxane HP would be very reasonable, um, but I think most of us will await regulatory approval, and once we have it, we'd certainly be thinking about TDXD, um, plus pertuzumab in this patient. This new regimen involves continuous ADC. Therapy rather than a finite chemotherapy induction. How does this shift our thinking about maintenance and long-term quality of life? Yes, so that is really the main um criticism, I think, of the Destiny Breast 09 clinical trial, where patients in the first line setting um were randomized to either the TDHD plus pertuzumab arm or TDXD arm. They got continuous TDXD with or without pertuzumab until progression or intolerable toxicity. Whereas the old paradigm in treating metastatic.