S15 Ep27: Show Me the Data™: Personalizing First-Line and Maintenance Therapy in HER2+ Metastatic Breast Cancer to Extend Survival and Elevate Quality of Life

Personalizing first-line and maintenance therapy for HER2-positive metastatic breast cancer requires integrating data-driven strategies for hormone receptor-positive patients. The PATINA trial demonstrates that adding the CDK4/6 inhibitor palbociclib to maintenance endocrine and HER2-targeted therapy significantly improves progression-free survival, reaching a median of 44 months compared to 29 months with endocrine therapy alone. Managing brain metastases remains a critical challenge, with emerging data highlighting the intracranial efficacy of T-DXd and the HER2-CLIMB regimen consisting of tucatinib, trastuzumab, and capecitabine. While ongoing clinical trials continue to evaluate novel combinations, including PI3K pathway inhibitors and immune checkpoint inhibitors, multidisciplinary coordination between medical and radiation oncology is essential for optimizing outcomes. Balancing treatment efficacy with patient-reported quality of life and individual preferences—such as managing the side effects of endocrine therapy—remains a central consideration in clinical practice.