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Expert Answers on First-line Maintenance Therapy for HER2-Positive Metastatic Breast Cancer

Clinical Thought

First-line maintenance therapy for HER2-positive metastatic breast cancer is evolving with emerging data on novel combinations and individualized treatment strategies. Recent changes to first-line maintenance therapy include the FDA approval of palbociclib for HR-positive/HER2-positive disease and the addition of tucatinib to trastuzumab and pertuzumab studied in HER2CLIMB-05. This expert commentary addresses practical questions on applying new evidence, personalizing maintenance therapy based on patient and disease factors, and managing toxicities that may affect adherence and outcomes.

Released: July 22, 2026

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Provided by Clinical Care Options, LLC dba Decera Clinical Education

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Supporters

Supported by an educational grant from Pfizer Inc.

Pfizer Inc.

Target Audience

This activity is intended for community medical oncologists, nurse practitioners, physician assistants, nurses, pharmacists, and other healthcare professionals who care for patients with breast cancer.

Learning Objectives

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

  • Educate patients on the clinical role and risk–benefit profile of first-line maintenance therapy for HER2-positive MBC

  • Evaluate the potential of novel combinations to optimize patient outcomes in the first-line maintenance setting for HER2-positive MBC using the latest evidence

  • Recommend the optimal first-line maintenance therapy for each eligible patient with HER2-positive MBC based on expert recommendations, evidence, HR status, and patient goals

  • Implement evidence-based multidisciplinary strategies to manage toxicities related to novel first-line maintenance therapies for HER2-positive MBC

Financial Disclosures

Primary Author

Erika Hamilton, MD, FASCO: researcher (paid to institution): AbbVie, Accutar Biotechnology, Artios, Arvinas, AstraZeneca, AtlasMedx, BeiGene, BeOne, Bicycle, Biohaven, BioNTech, Compugen, Cullinan, Daiichi Sankyo, Dantari, Day One Biopharmaceuticals, Duality Biologics, Ellipses, Elucida Oncology, Exelixis, FujiFilm, Genmab, Gilead, H3 Biomedicine, Iambic Therapeutics, Immunogen, Inspirna, InventisBio, Jacobio, Jazz, K-Group Beta, Kind, Lilly, Loxo Oncology, Mabspace, Mabwell, Marengo, MediLink, Merck, Mersana, Novartis, Olema, Orinove, Orum, Pfizer, Pionyr, Prelude, Profound Bio, Regeneron, Relay, Rgenix, Roche/Genentech, SeaGen, Shattuck Labs, Simcha, Stemline, Sutro, Systimmune, Taiho, Tesaro, TheRas, Treadwell, Verastem, Xadcera, Zymeworks; consultant/advisor (paid to institution): Arvinas, AstraZeneca, BeOne, BioNTech, Boehringer Ingelheim, Boundless Bio, Bristol Myers Squibb, Circle, Daiichi Sankyo, Gilead, Halda, Incyclix, IQVIA, Janssen, Jazz, Jefferies, Johnson & Johnson, Lilly, Mersana, Novartis, Pfizer, Precede, Pyxis Oncology, Roche/Genentech, Samsung Bioepis, Shorla, Stemline, Tempus.

Otto Metzger, MD: advisor: AstraZeneca, Daichii Sankyo, Jazz, Pfizer; researcher: Pfizer.

Additional Disclosures

Generative artificial intelligence (AI) tools were used for drafting educational content, revising or refining educational content, and drafting assessment question(s) and/or rationale(s). All AI-assisted content underwent human review, editing, and validation by qualified faculty and accredited education staff to ensure scientific accuracy, balance, and compliance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education.