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Breast Cancer — SCE Medical Oncology MCQ

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HardBreast CancerBreast CancerSCE Medical Oncology

A patient with HER2-positive metastatic breast cancer has active brain metastases and progression after trastuzumab, pertuzumab and a taxane followed by trastuzumab emtansine. Which NHS-funded systemic option is specifically positioned after at least two anti-HER2 regimens and has randomised evidence including active brain metastases?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Tucatinib with trastuzumab and capecitabine

NICE TA786 positions tucatinib with trastuzumab and capecitabine after two or more anti-HER2 regimens. HER2CLIMB included patients with brain metastases. The other combinations either mix unlicensed partners, recycle a failed agent, or lack this appraisal position and evidence base.

Reference: NICE TA786: tucatinib with trastuzumab and capecitabine. https://www.nice.org.uk/guidance/ta786/chapter/1-Recommendations