ReviewTranslational breast cancer research : a journal focusing on translational research in breast cancer2026
Therapeutics and toxicity management of human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer: a narrative review.
Review in Translational breast cancer research : a journal focusing on translational research in breast cancer, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and Objective: Development of anti-human epidermal growth factor receptor 2 (HER2) therapy has dramatically changed the prognosis of HER2-positive metastatic breast cancer (MBC), which is intrinsically aggressive. The objective of this review is to summarize the current treatment options and supportive care strategies for patients with HER2-positive MBC. Methods: This review discusses the available evidence for the systemic treatment of HER2 positive MBC, management of central nervous system (CNS) metastases, and supportive care for patients receiving anti-HER2 therapy. Key Content and Findings: Trastuzumab and pertuzumab combined with taxane has been the standard first-line treatment, supported by the CLEOPATRA trial. Trastuzumab deruxtecan (T-DXd) has shown superior efficacy compared to trastuzumab emtansine (T-DM1) and is currently the preferred second-line treatment. The DESTINY-Breast09 study has suggested that T-DXd plus pertuzumab may outperform the current first-line regimens. Tucatinib could improve the survival of patients with brain metastases and may be a key option for later lines. Brain metastases remain a major challenge, affecting up to 50% of the patients. T-DXd has demonstrated intracranial efficacy in both clinical trials and real-world studies, including studies involving patients with leptomeningeal diseases. Supportive care for patients with cardiac toxicity, nausea, vomiting, and interstitial lung disease (ILD) is essential. The development of anti-HER2 therapies, including T-DXd, has dramatically transformed the treatment landscape for HER2-positive MBC. However, treatment options after T-DXd progression and long-term management of side effects remain ongoing challenges. Conclusions: T-DXd has redefined the standard of care for HER2-positive MBC, potentially improving outcomes even with CNS metastases. However, post-T-DXd strategies and management of long-term toxicities remain key challenges.
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