How do you reconcile data from the PATINA trial and DESTINY-Breast09 with respect to CDK4/6 inhibitor maintenance in metastatic ER+ HER2+ breast cancer?  

We don't have data on using T-DXd with palbociclib concurrently, but the data from DB09 and PATINA does lead to questions about the optimal 1st line approach in ER+HER2+ metastatic disease. DB09 allowed for concurrent endocrine therapy with T-DXd + P, and the ADC was continued until intolerance or p...

I think of PATINA and DESTINY-Breast09 as addressing different treatment phases rather than offering competing strategies. PATINA clearly supports the ongoing role of estrogen receptor signaling in ER-positive, HER2-positive metastatic disease and shows that adding a CDK4/6 inhibitor to endocrine th...

I am not adding CDK4/6 inhibitors to T-DXd outside of a clinical trial. In patients with ER+/HER2+ MBC who received 1L THP, I am routinely offering HP/palbociclib/ET in the maintenance setting. For patients with ER+/HER2+ MBC who received 1L T-DXd/P, it is unknown what the outcomes will be with some...