# Tucatinib + trastuzumab + capecitabine for brain metastases

Source: https://onco.cc/pairings/tucatinib-triplet-brain-mets/  
OnCo record `tucatinib-triplet-brain-mets` (Pairing). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The one regimen proven in a randomised trial to help HER2-positive brain metastases, extending survival in those patients by six months.

## Summary

This combination gives tucatinib with trastuzumab and capecitabine to patients with HER2-positive breast cancer and brain metastases. Tucatinib is a small, HER2-selective molecule that crosses the blood-brain barrier, capecitabine adds a cytotoxic effect that is active in the central nervous system, and trastuzumab maintains systemic control. In the phase 3 HER2CLIMB trial, which included dedicated analyses of patients with brain metastases, the regimen improved intracranial progression-free survival and overall survival and produced responses in both untreated and previously treated brain lesions. It remains the one regimen shown in a randomised trial to help HER2-positive brain metastases, and it allows whole-brain radiation to be deferred in selected cases.

## Fields

- Kind: Pairing
- Last checked: 2026-09-07
- Pairs: Tucatinib + Trastuzumab
- Type: combination
- Rationale: Tucatinib is a small, HER2-selective molecule that crosses the blood-brain barrier; capecitabine adds CNS-active cytotoxic effect; trastuzumab maintains systemic control.
- Evidence: Phase 3 (HER2CLIMB) with dedicated CNS analyses.

## Sources

- ClinicalTrials.gov NCT02614794: HER2CLIMB: https://clinicaltrials.gov/study/NCT02614794

## Connected records

- cancers: [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HER2-positive breast cancer with brain metastases](https://onco.cc/cancers/her2-positive-breast-brain-metastases/)
- drugs: [Trastuzumab](https://onco.cc/drugs/trastuzumab/), [Tucatinib](https://onco.cc/drugs/tucatinib/)
- terms: [HER2-positive brain metastases](https://onco.cc/terms/her2-brain-metastases/)
- trials: [HER2CLIMB](https://onco.cc/trials/her2climb/)

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