Dr Gallagher on Unmet Needs With ADCs in Breast Cancer

Christopher M. Gallagher, MD, medical director, Cancer Services, Washington Cancer Institute, teaching attending physician, MedStar Washington Hospital Center, discusses unmet needs surrounding the use of antibody-drug conjugates (ADCs), as well as questions remaining with other approved agents in breast cancer.

The treatment armamentarium of breast cancer therapeutics continues to advance, presenting opportunities for greater benefit with novel strategies and challenges when harnessing current agents, Gallagher begins. Although ADCs demonstrate heightened efficacy compared with standard chemotherapy, managing patients’ associated toxicities remains a critical unmet need, Gallagher states. Identifying biomarkers for predicting toxicity, particularly in individuals whose disease characteristics disqualify them as candidates for treatment with certain drugs, is also an ongoing challenge, Gallagher adds.

With the continued emergence of ADCs in the breast cancer treatment space, the sequencing of approved agents has become increasingly uncertain, Gallagher continues. Agents like datopotamab deruxtecan (Dato-DXd; DS-1062a) and sacituzumab govitecan-hziy (Trodelvy), the latter of which is currently under investigation in combination with immunotherapy, have demonstrated promising efficacy in patients with breast cancer, he says. However, the incorporation of such regimens into the current armamentarium may further confound treatment selection, Gallagher speculates.

Clinicians often select a therapeutic approach for patient with metastatic breast cancer directly based on the latest research, Gallagher explains. However, ongoing trials assessing post-neoadjuvant therapy and different neoadjuvant therapies may use these agents at earlier stages on metastatic disease management, complicating decision-making, he emphasizes.

Addressing these challenges requires a comprehensive understanding of treatment outcomes, emphasizing the need to clarity sequencing decisions based on evolving therapeutic paradigms, Gallagher states. Oncologists anticipate that results from ongoing trials could better elucidate breast cancer treatment strategies and enhance therapeutic decision-making, Gallagher concludes.