HR+ Breast Cancer: Treatment Advances and Highlights from ASCO 2025 - Episode 11
Panelists discuss how subgroup analyses from DESTINY-Breast06 show trastuzumab deruxtecan benefits across different mutation groups, with particularly strong responses in patients with BRCA1/2-mutated disease due to the topoisomerase I inhibitor payload.
ADC Toxicity Management and Quality-of-Life Considerations
Managing antibody-drug conjugate (ADC)–related toxicities requires specialized knowledge and proactive strategies, particularly for ocular toxicity and stomatitis associated with datopotamab deruxtecan. Ocular complications represent a relatively new challenge in breast cancer treatment, requiring adaptation from management strategies used in other solid tumor types. Prophylactic measures include regular artificial tears, avoiding contact lens use during treatment, and close ophthalmologic monitoring for signs of keratitis or severe dry eye syndrome.
Stomatitis management with datopotamab deruxtecan benefits significantly from prophylactic dexamethasone mouthwash initiated at treatment start rather than waiting for symptoms to develop. Both ocular toxicity and severe stomatitis can substantially affect quality of life, with eating difficulties and visual impairment affecting daily functioning. Experience from clinical trials, including the I-SPY 2 study, demonstrates the effectiveness of early intervention strategies in maintaining treatment adherence and patient comfort.
Neutropenia management with sacituzumab govitecan requires recognition of its high febrile neutropenia risk, recently reflected in updated prescribing information. Prophylactic growth factor support typically administered on day 8 of each cycle helps mitigate this risk and maintain dose intensity. The distinct toxicity profiles of different ADCs allow for individualized selection based on patient comorbidities, lifestyle factors, and tolerance for specific adverse effects.