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MEDTECH Advancing Breast Cancer Treatment: Groundbreaking Insights from SABCS 2023 Illuminate Pathways to Enhanced Therapeutic Strategies
The 2023 San Antonio Breast Cancer Symposium unveiled pivotal findings in the realm of metastatic breast cancer, offering a beacon of hope through innovative therapies and strategic treatment advancements. This comprehensive synthesis distills crucial insights from seven key trials, shedding light on the nuanced interplay of novel agents and their potential to redefine the landscape of breast cancer management, with a particular focus on antibody-drug conjugates and targeted therapies.
- TROPiCS-02 Study: Sacituzumab govitecan vs treatment of physician’s choice in HR+/HER2– metastatic breast cancer.
- Sacituzumab govitecan showed superior median PFS and OS.
- Benefits were observed across all age subgroups.
- Commentary: Emphasizes the favorable benefit-to-risk profile of sacituzumab govitecan, especially in older patients, advocating for its selection in this demographic.
- Sequential Use of ADCs (General Commentary):
- Sequential ADC therapy indicated diminishing PFS with the second ADC.
- Potential cross-resistance between ADCs was noted.
- Commentary: Suggests a need for biomarker identification to predict benefits from second ADC therapies and posits an overall survival benefit when trastuzumab deruxtecan precedes sacituzumab govitecan.
- TROPION-Breast01: Datopotamab deruxtecan vs chemotherapy in HR+/HER2– metastatic breast cancer.
- Datopotamab deruxtecan significantly improved PFS compared to chemotherapy.
- Showed benefits across various subgroups, including those with brain metastases and prior CDK4/6 inhibitor treatment.
- Commentary: Highlights the superiority of datopotamab deruxtecan in efficacy, safety, and quality of life compared to standard chemotherapy, suggesting its potential approval for this indication.
- HER2CLIMB-02 Trial: Tucatinib plus trastuzumab emtansine in HER2-positive metastatic breast cancer.
- The combination showed improved PFS compared to the control.
- Notable benefits were observed in patients with brain metastases.
- Commentary: Supports the potential of combination therapy to enhance outcomes, highlighting the need for further data before routine clinical integration.
- EMERALD Trial: Elacestrant vs standard-of-care in ER+/HER2– metastatic breast cancer with ESR1 mutations.
- Elacestrant demonstrated superior PFS in patients with ESR1 mutations.
- Benefits were consistent across various biomarker subgroups.
- Commentary: Reinforces elacestrant’s efficacy post-CDK4/6 inhibitor treatment, emphasizing its targeted use in patients with specific genetic alterations.
- A3 Study: Sequencing of ADCs in metastatic breast cancer.
- This study noted reduced efficacy with the second ADC in sequence.
- Highlighted cross-resistance but also some benefit from sequential ADC use.
- Commentary (General for ADC Sequencing): Indicates the importance of strategic sequencing of ADCs, considering potential cross-resistance while acknowledging some patients still benefit from sequential therapy.
- ADC Low Study: Efficacy of sacituzumab govitecan post trastuzumab deruxtecan and vice versa.
- Showed a trend towards better outcomes when sacituzumab govitecan was used first, though not statistically significant.
- Explored the effects of sequencing on patient outcomes.
- Commentary (General for ADC Sequencing): Suggests a potential preference for using trastuzumab deruxtecan before sacituzumab govitecan, aligning with practices to optimize patient responses in HER2-low metastatic breast cancer.
“Remarkably, all [ADC] studies reported somewhat similar results, indicating that progression-free survival (PFS) was longer in patients who received a first ADC (ADC1) than in those who received a second ADC (ADC2) after ADC1.”
– Aditya Bardia, MD; Medical Oncologist, Massachusetts General Hospital
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