Rechallenge Strategies, Practice Logistics, and Patient Communication Regarding ADCs in Breast Cancer

This combined section explores three key aspects of ADC use that frequently influence real world practice. The discussion begins with ADC rechallenge. The experts explain that most resistance patterns arise from changes in payload sensitivity rather than complete absence of the target. Because many ADCs use topoisomerase 1 inhibitor payloads, switching immediately from one to another may produce limited benefit. They describe the value of introducing a break with chemotherapy or choosing an ADC with a different payload to restore treatment sensitivity.

The conversation then transitions to practical issues related to infusion and monitoring. Dr Tarantino explains that ADC administration requires careful coordination among clinicians, pharmacists, and nursing staff. He highlights the importance of early and structured monitoring for interstitial lung disease with trastuzumab deruxtecan, ocular symptoms with datopotamab deruxtecan, and neutropenia with sacituzumab govitecan. The experts point out that organized workflows can reduce treatment delays and help maintain optimal dose intensity.

The final part of this section discusses communication strategies for patients. Many individuals remain uncertain about whether they are receiving chemotherapy or targeted therapy. Dr Mouabbi explains that he describes ADCs as a form of targeted chemotherapy delivered with greater selectivity. He notes that this explanation improves patient understanding and encourages adherence. He also highlights the value of discussing treatment expectations openly, including supportive care measures that reduce the impact of toxicity.

Together, these discussions provide actionable guidance for clinicians integrating ADCs into routine practice. They emphasize evidence based sequencing, structured monitoring, and clear communication as essential components of successful ADC treatment in breast cancer.