Case 2: Clinical Experience With Trastuzumab Deruxtecan in HER2+ mBC

EP: 1.Case 1: Neoadjuvant Therapy for Early-Stage HER2+ BC

EP: 2.Case 1: Neoadjuvant Treatment Armamentarium for Early-Stage HER2+ BC

EP: 3.Case 1: Selecting Adjuvant Therapy for Early-Stage HER2+ BC

EP: 4.Case 1: Subcutaneous HP FDC Formulation in Early-Stage HER2+ BC

EP: 5.Case 2: Overview of Treatment Strategies for HER2+ Metastatic BC

EP: 6.Case 2: DESTINY-Breast03 and T-DXd in HER2+ Metastatic BC

EP: 7.Case 2: Addressing ILD Associated With HER2-Targeted Therapy in mBC

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EP: 8.Case 2: Clinical Experience With Trastuzumab Deruxtecan in HER2+ mBC

EP: 9.Case 3: Selecting Therapy For HER2+ Breast Cancer With Brain Metastases

EP: 10.Case 2: Third-Line Therapy and Beyond in HER2+ Metastatic Breast Cancer

EP: 11.Case 3: HER2+ mBC Treatment After Progression on the HER2CLIMB Regimen

EP: 12.Case 3: CNS Data From Clinical Trials in HER2+ BC

EP: 13.Emerging Treatment Approaches in HER2+ Breast Cancer

EP: 14.Case 1: Risk Assessment and Treatment Selection in Early-stage HER2+ BC

EP: 15.Case 1: Subcutaneous vs Intravenous Trastuzumab/Pertuzumab

EP: 16.Case 2: Second-line Treatment Selection for Metastatic HER2+ BC

EP: 17.Case 2: Safety Considerations in the Use of T-DXd for HER2+ mBC

Transcript:

Sara A. Hurvitz, MD: This patient did receive trastuzumab deruxtecan [T-DXd]. Remember, she had THP [docetaxel, trastuzumab, pertuzumab] induction for her de novo disease, had a great response lasting 18 months, progressed in the liver, and now she’s had T-DXd, with a partial response in both the breast mass as well as the liver lesions. We’ve talked a lot now about the toxicity of this therapy. I want to hear what your experience has been on a personal level with your patients with this drug. What have you noted in the clinic, Bill?

William J. Gradishar, MD: Most of our patients have responded; I can’t think of anybody who did not. I haven’t had anybody who had any significant ILD [interstitial lung disease] to date, and I think I’m seeing responses in those with CNS [central nervous system] disease as well. You mentioned the data with stable brain metastases, but there are data with some patients with active brain metastases as well. I think it is a very active drug. To date the toxicity that our group has seen has been modest, but we’re vigilant in looking for it and being sensitive to it. It inevitably will stop working, but to date it’s been a very active, very good drug.

Sara A. Hurvitz, MD: Sara, your experience as well?

Sara M. Tolaney, MD, MPH: It’s amazing to see the responses with this drug. When the drug first got FDA approved based on DB01 [DESTINY-Breast01 trial], we were using it in very late-line patients because there had been patients who didn’t have access to it until they had been through multiple lines of therapy. These are people who were progressing through several lines, and then all of a sudden had home run responses as their 7th or 8th line of therapy. It was unreal, and now it’s so nice to be able to use it earlier. The trick that we have learned though is that it does cause nausea for many people, so we do give prophylactic antiemetics with each dose. Some people are using Decadron, Aloxi, and Emend; some people can get away with just Decadron and Aloxi. Then some people need to use Zofran, even in week 2 and 3, there’s this delayed nausea that can happen. That has been helpful to many people to have access to that. We do sometimes see some hair thinning as you pointed out. I too have not had anyone go bald, but it is about a 10% rate of grade 2 that’s been noted with this agent. We don’t know if scalp cooling works, we have a trial ongoing at our institution [Dana-Farber Cancer Institute] looking at that, so we’ll see if that helps. But again it’s generally well tolerated, just some fatigue, nausea; those are the main symptoms I tend to notice.

Sara A. Hurvitz, MD: There are a lot of eyes on your data relating to the scalp cooling. We’re all waiting to see how that pans out with something that has a longer half-life. One wonders if it’s going to work, but we’re all hoping that in some way it will help.

Transcript edited for clarity.