HR+ Breast Cancer: Treatment Advances and Highlights from ASCO 2025 - Episode 7
TROPiCS-02 Trial: Sacituzumab Govitecan in HR+/HER2– Breast Cancer
Panelists discuss how the TROPiCS-02 trial established sacituzumab govitecan for hormone receptor–positive, HER2-negative metastatic breast cancer and how it influences sequencing decisions with other antibody-drug conjugates (ADCs) such as trastuzumab deruxtecan.
Antibody-Drug Conjugate Integration and Treatment Timing
Antibody-drug conjugates represent a paradigm shift in hormone receptor–positive breast cancer treatment, with careful consideration required for optimal timing in the treatment sequence. ADC implementation depends on assessment of continued endocrine receptor pathway dependence and sensitivity to hormonal manipulation. Primary endocrine resistance, representing approximately 10% of patients in the DESTINY-Breast06 trial, constitutes an early indication for ADC consideration rather than continued endocrine-based approaches.
The decision to transition from targeted endocrine therapy to ADCs involves multiple clinical factors, including treatment duration patterns, disease pace, symptom burden, and potential for visceral crisis. Sequential endocrine therapies typically show progressively shorter durations of benefit, and when this pattern accelerates significantly, ADC therapy becomes appropriate. The high objective response rates with ADCs make them particularly valuable for patients requiring rapid disease control or “firefighting” scenarios.
Clinical implementation requires balancing the established efficacy of ADCs against continued opportunities for endocrine-based treatment in hormone-sensitive disease. The goal remains maximizing time on targeted therapies while ensuring timely transition to ADCs when endocrine resistance becomes apparent. This decision-making process involves ongoing
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