Topics:
Breast Cancer • Medical Oncology • Her2+ • Journal Club ft. NEJM publications • Breast Cancer, Metastatic
When, if ever, will you utilize T-DM1 in metastatic HER2+ breast cancer given trastuzumab deruxtecan's significantly improved PFS vs T-DM1?
The FDA recently approved trastuzumab deruxtecan (T-DXd) in the second line setting. Given the results of DESTINY-Breast03, what is now the role of TDM1 in the treatment armamentarium of HER2+ metastatic breast cancer?
Can trastuzumab emtansine still be effective in sequence after progression on trastuzumab deruxtecan?
Answer from: Medical Oncologist at Community Practice
With the data we have, it is quite clear to understand that T-DXd should replace T-DM1 as the best treatment option for second line therapy; however, for those patients with a history of previous pneumonitis or significant lung disorders, T-DM1 is still the preferred option.
For those patients who ...
Answer from: Medical Oncologist at Academic Institution
At this juncture, we do not know the efficacy of T-DM1 after T-DXd. I think for those patients who develop ILD or for whom, THP or T-DXd are too toxic or may have low volume metastatic disease, T-DM1 remains a good alternative. There are some single arm studies that have combined T-DM1 with HER2 TKI...
Answer from: Medical Oncologist at Community Practice
I completely agree that TXD is more tempting given the data. However, I think T-DM1 still has a role as second line in the absence of myelotoxicity, neuropathy issues, absence of CNS disease, and slowly progressive disease/low disease burden. For now, using TXD as it is approved allows more treatmen...
Answer from: Medical Oncologist at Academic Institution
There may still be a role for T-DM1 in a patient who has been exposed to several regimens including all approved/NCCN-recommended regimens, or who may be intolerant or have contraindications to kinase inhibitors or to topoisomerase I inhibitors. However, 2nd and 3rd generation antibody-drug conjugat...
Will you be using Trastuzumab deruxtecan (T-DXd) i...
We have no data to support replacing T-DM1 with T-...
Thank you.