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How do you approach choice of second-line therapy in metastatic TNBC after progression on 1L TROP2 ADC?

If there was rapid progression on the first line agent, would you still consider sequencing an alternate ADC or try to switch regimens otherwise?
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After progression on a 1L TROP2 ADC, what is your preferred 2L approach?

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3 Answers
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Medical Oncology · Mary Lanning Healthcare Morrison Cancer Center/University of Nebraska Medical Center Adjunct Faculty
Answered on

The emerging consensus on the mechanism of resistance to ADC drugs suggests that payload-mediated resistance predominates over target antigen loss, though both mechanisms operate and their relative contributions differ by disease context. T-DXd-resistant (TDXd-R) and SG-resistant (SG-R) breast cance...

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Medical Oncology · Emory University School of Medicine
Answered on

The movement of TROP2 ADCs into the first-line setting, supported by ASCENT-03 and TROPION-Breast02, has created an important unmet need in the post-TROP2 ADC setting. These data are likely to reshape first-line treatment for patients with locally advanced unresectable or metastatic TNBC who are not...

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Medical Oncology · Memorial Sloan Kettering Cancer Center
Answered on

Unfortunately, we lack prospective randomized data to guide sequencing decisions. Many retrospective series have suggested ADC2 does not perform as well as ADC1. We have also seen high attrition rates line after first line of therapy, arguing to use our most active agents earlier. We do not yet have...

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