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Optimizing Treatment Sequencing in HER2-Positive Metastatic Breast Cancer

Slideset

This slideset with an accompanying video module examines the rapidly evolving treatment landscape for HER2-positive metastatic breast cancer, focusing on evidence from key clinical trials that are reshaping first-line therapy, maintenance strategies, and treatment sequencing. Explore how emerging data on HER2-directed therapies inform individualized treatment decisions, including when to incorporate T-DXd, tucatinib, and other targeted approaches, how to navigate limited evidence following T-DXd progression, and how to integrate systemic and local therapies for patients with CNS metastases.

Released: October 09, 2026

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Faculty

Sara A. Hurvitz

Sara A. Hurvitz, MD, FACP

Professor of Medicine
Smith Family Endowed Chair in Women’s Health
Senior Vice President, Clinical Research Division
Fred Hutchinson Cancer Center
Head, Division of Hematology and Oncology
Department of Medicine, UW Medicine
Seattle, Washington

Provided by

Provided by Clinical Care Options, LLC dba Decera Clinical Education

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Supporters

This activity is supported by educational grants from AstraZeneca and Daiichi Sankyo, Inc.

AstraZeneca

Daiichi Sankyo, Inc.

Target Audience

This activity is intended for oncologists, advanced practice providers, nurse practitioners, clinical nurse specialists, nurses, pharmacists, physician associates, and other health care professionals who care for patients with HER2-positive breast cancer.

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Select appropriate neoadjuvant HER2-targeted regimens for patients with HER2-positive early breast cancer using clinical factors such as tumor size, nodal status, and hormone receptor expression

  • Determine when to escalate, maintain, or de-escalate therapy during the transition from neoadjuvant to adjuvant treatment, including appropriate use of T-DM1 for residual invasive disease and identification of patients who may benefit from trastuzumab-based maintenance

  • Choose evidence-based first- and later-line HER2-targeted regimens in metastatic settings based on prior treatments, CNS involvement, comorbidities, and toxicity risk profiles

  • Modify sequencing decisions in response to clinical changes, including therapy discontinuation due to toxicity, HER2 loss after neoadjuvant treatment, ILD risk with ADCs, cardiotoxicity, or evolving patient preferences

  • Counsel patients using clear, individualized explanations of how and why HER2-targeted therapies are sequenced across the continuum of care and how treatment transitions may affect outcomes and quality of life