Dr D'Abreo on the Evolution of ADC Use in the HER2+ Breast Cancer Treatment Landscape

Nina D'Abreo, MD, assistant professor, Department of Medicine, New York University Grossman School of Medicine, chief, Division of Hematology and Medical Oncology, Perlmutter Cancer Center, discusses the evolution of antibody-drug conjugates (ADCs) in the treatment of patients with HER2-low or HER2-positive breast cancer.

ADCs have become a prominent option in the current breast cancer treatment landscape, and represent a key advancement in breast cancer care, D'Abreo begins. Strategic deployment of these ADCs is vital to optimize their impact, not only in advanced stages of breast cancer but also in the early disease stages, D’Abreo. This includes both neoadjuvant and adjuvant settings, she adds. Innovative combinations of ADCs and oral therapies are currently being explored and are of particular interest in adjuvant settings. The phase 3 CompassHER2 RD trial (NCT04457596) is one such study of adjuvant ado-trastuzumab emtansine (Kadcyla; T-DM1) plus placebo vs T-DM1 and tucatinib (Tukysa) in this space, D'Abreo notes.

Additionally, there is a notable shift towards chemotherapy-free approaches in breast cancer. This is exemplified by ongoing trials of regimens minimizing or entirely excluding cytotoxic therapies through the inclusion of ADCs, she expands. A pivotal aspect in these trials is the meticulous process of patient selection, D'Abreo says. Translational medicine plays a crucial role in identifying individuals who benefit from these trials using tools such as genomics, she emphasizes. Some trials have already utilized these assays.

Radiology also emerges as a valuable tool in aiding treatment decision-making, she continues. The focus is now on discerning intrinsic subtypes, which can identify the patients who may gain the most from these chemotherapy-free alternatives, D'Abreo imparts. The evolving landscape in breast cancer underscores the notion that a one-size-fits-all approach is outdated, she emphasizes. Instead, the field is focused on tailoring treatments, minimizing toxicity, and optimizing therapeutic interventions for patients deserving access to specific biological tools in addition to traditional PCR, she explains. This dynamic approach holds promise and marks an exciting phase in the field, D'Abreo concludes.