In a patient with HER2+ breast cancer treated with T-DXd in neoadjuvantly who has residual disease on surgical pathology, what will be your adjuvant therapy approach and why?

This is something my colleagues at Winship and I are actively discussing, and I think this will depend on the individual patient situation. Questions that I think are pertinent include: How much residual disease does the patient have? What is the planned RT course? How did the patient tolerate neoad...

In the DESTINY-Breast11 trial, patients with > T3, or N+ or inflammatory breast (although the FDA approval included T2N0) who had residual disease got the standard of care at the time, which was T-DM1 x 14 cycles. However, recently adjuvant T-DXd was approved based on the DESTINY-Breast05 data for p...

There’s no data to guide decision-making in this situation. In addition to neoadjuvant treatment tolerance and “degree” of response based on final pathology, the HR status of the tumor could influence recommendations for adjuvant treatment. For example, HR negative tumor with a good but incomplete r...

I would probably use T-DM1 in the adjuvant setting for residual disease.