Dr Tan on the Management of ADC-Related Toxicities in Breast Cancer

“In general, antibody-drug conjugates have less treatment-related toxicity compared with standard chemotherapy management [for breast cancer]. There does need to be proactive management of toxicities from ADCs to prevent dose-limiting [adverse] effects.”

Antoinette Tan, MD, MHS, chair of the Department of Solid Tumor and Investigational Therapeutics, chief of the Section of Breast Medical Oncology, and director of the Phase I Program at Atrium Health Levine Cancer; and a clinical professor in the Department of Internal Medicine, Wake Forest University School of Medicine, discussed the safety profile of antibody-drug conjugates (ADCs) for the treatment of patients with breast cancer.

Compared with traditional chemotherapy regimens for the treatment of patients with breast cancer, ADCs generally lead to less treatment-related toxicity, Tan began. Still, the management of toxicities from ADCs should remain a priority to prevent dose-limiting adverse effects (AEs), she noted. Additionally, it’s important to consider dose reduction as a generally effective option to help mitigate ADC-related toxicities, she asserted.

In the current breast cancer landscape, Tan also emphasized that there are a plethora of different types of ADCs that have different targets and payloads, which could affect the AEs that patients may experience. Specifically, if 2 ADCs have the same target but different payloads, the ADCs may demonstrate different safety profiles, she explained. For example, treatment with sacituzumab govitecan-hziy (Trodelvy), a TROP2-directed ADC with an SN-38 payload, has a safety profile that comprises mild suppression with some gastrointestinal toxicities, which is commonly diarrhea, she continued. If a patient presents with conditions that may be prone to causing diarrhea, Tan explained that she may consider choosing a different ADC that is the best fit for the patient.

Furthermore, treatment with fam-trasutuzmab deruxtecan-nxki (T-DXd; Enhertu) has a known safety profile that could lead to interstitial lung disease, Tan added. When considering this treatment, she also acknowledges any underlying lung conditions patients may have, which could arise from prior therapies. Overall, considering patients’ conditions before treatment with ADCs is crucial, especially with limited prospective data on the most recently FDA-approved ADCs for breast cancer, Tan concluded.