The Landscape of Breast Cancer Treatments

In a groundbreaking forum, a dynamic group of cancer care experts, including leading oncologists, nurses, and pharmacists, unveiled their strategies for treating elusive breast cancer subtypes—triple-negative breast cancer (TNBC) and hormone receptor-positive, HER2-negative metastatic breast cancer. This high-stakes discussion was part of a CancerNetwork-hosted Satellite Sessions program where the panel experts, led by Dr. Manali Bhave and Dr. Jade E. Jones from Emory University, dived deep into the nuances of when to deploy cutting-edge immunotherapies, particularly antibody-drug conjugates (ADCs). These specialized treatments, including fam-trastuzumab deruxtecan-nxki (T-DXd; Enhertu), sacituzumab govitecan-hziy (Trodelvy), and datopotamab deruxtecan-dlnk (Dato-DXd; Datroway), hold the potential to change the game in cancer therapy.

Making the Right Immunotherapy Choices

During the panel, the experts tackled the monumental question: how to decide on immunotherapy for patients with metastatic TNBC. Dr. Shipra Gandhi emphasized the significance of tumor mutation burden as a guiding factor, especially in situations where PD-L1 tests return negative. "If there's high tumor mutation burden, I would consider pairing pembrolizumab (Keytruda) with chemotherapy, even if PD-L1 is negative," she explained.

The discussion didn’t stop there; the panelists explored the evolving potential of tumor-infiltrating lymphocytes (TILs) in chemotherapy efficacy. The innovative NeoTRACT trial is investigating the implications of TIL levels, indicating that high TIL counts could steer treatment choices effectively.

ADCs: Timing and Strategy for Implementation

But when is the right time to introduce ADCs in therapy? Dr. Sri Lakshmi S. Kollepara illustrated that even with PD-L1-negative TNBC, the search for BRCA or HRR mutations is crucial. Typically, oncologists initiate treatment with standard chemotherapy before transitioning patients to ADCs after a couple of therapy lines. Dr. Mayur Mody indicated a preference for using cytoreductive chemotherapy first due to the aggressive nature of TNBC, keeping ADCs reserved for later.

The complexities of patient care were further highlighted when discussing those who experience recurrence shortly after surgery. For patients struggling within six months post-surgery, Dr. Jade E. Jones advocates for early administration of ADCs, particularly sacituzumab govitecan, citing better outcomes compared to delaying treatment.

Choosing the Right ADC: Factors to Consider

As the conversation progressed, the panel grappled with the variance in trial outcomes and their impact on ADC selection. Dr. Gandhi noted that differences in trial design must be scrutinized when considering overall survival benefits, particularly with Dato-DXd. The adverse event profiles of these therapies are critical in guiding treatment choices.

There was also an acknowledgment of the logistical challenges posed by treatment side effects. From neutropenia to nausea, proactive management strategies, including tailored antiemetic regimens, were discussed to enhance patient comfort during treatment, as highlighted by clinical pharmacist Gaybrielle Moore.

Real-world Case Studies: Navigating Challenges

A compelling real-world case involved a 68-year-old patient with HR-positive breast cancer who experienced severe neutropenia after her first dose of sacituzumab govitecan. Panelists discussed strategies to monitor and manage such side effects effectively, emphasizing the importance of timely intervention with growth factors.

The consensus was clear: navigating ADCs in breast cancer treatment is multifaceted, requiring a strategic approach rooted in the latest research and real-world experiences. As the panelists concluded their session, the promise of ADCs and personalized treatment pathways continued to shine bright on the horizon for breast cancer patients, signaling hope and targeted therapy options.