During a Case-Based Roundtable® event, Timothy J. Pluard, MD, explores datopotamab deruxtecan as an option in hormone receptor–positive, HER2-negative breast cancer in the second article of a 2-part series.
Timothy J. Pluard, MD
Medical Director
Saint Luke’s Cancer Institute
Kansas City, MO
CASE SUMMARY
Two Years After Completing Adjuvant Therapy
After 16 Months on Treatment
Next-generation sequencing (NGS) detected a pathogenic hot spot mutation in PIK3CA and no other alterations.
After 10 Months on Treatment
After 8 Months on Treatment
Targeted Oncology: Can you discuss why datopotamab deruxtecan [Dato-DXd] would be an option for this patient and the data behind it?
TIMOTHY J. PLUARD, MD: Dato-DXdis a TROP2-directed antibody-drug conjugate [ADC] and has the same payload as trastuzumab deruxtecan [Enhertu].1 The only thing that's different between this and trastuzumab deruxtecan is the TROP2 antibody as opposed to a HER2 antibody. The drug-to-antibody ratios are a little bit different at 4. It's every-3-week dosing schedule for hormone receptor [HR]–positive, HER2-negative breast cancer and triple-negative breast cancer.
TROPION-Breast01 [NCT05104866] was a trial of patients previously treated with 1 to 2 lines of chemotherapy in the metastatic setting and had to be endocrine refractory or not eligible for endocrine therapy. Dato-DXd was given at 6 mg/kg every 3 weeks and the chemotherapy was treatment of physician's choice. The end points were progression-free survival [PFS] per RECIST and overall survival [OS].
What were the efficacy and safety on the TROPION-Breast01 trial?
The median PFS improved from 4.9 months [with investigator's choice] to 6.9 months in the Dato-DXd arm [HR, 0.63; 95% CI, 0.52-0.76; P < .0001], and median PFS by the investigator was similar [6.9 vs 4.5 months, respectively].2 OS had not matured yet. The overall response rate was higher with Dato-DXd at 36.4% vs 22.9% with investigator’s choice of chemotherapy, so there was a benefit there. Avoiding the pitfalls of cross-trial comparisons, the drug has, at least in this study, fairly comparable benefit with sacituzumab govitecan [Trodelvy]. Looking at...12-month landmark analysis, it's 25.5% PFS rate vs 14.6% [with Dato-DXd vs chemotherapy, respectively].
The only unique toxicity that appeared in this [trial] was some dry eye or ocular events, generally of low grade. But 22% had some grade of dry eye, with 1 patient discontinuing treatment due to ocular toxicity [vs 8% with any-grade dry eye with chemotherapy]. There is a little bit more in terms of stomatitis [when receiving Dato-DXd], with 50% having some degree of stomatitis [vs 13% with chemotherapy].
Do you use Dato-DXd therapy at your practice?
We have this drug as part of a clinical trial here. We've had a few patients on it. It's too early to tell how they're doing, but the more drugs [as options], the better, so I am anxious to see how this matures…. We don't have OS data for this agent; that may change some people's thinking about where and how to use this if the OS data are not comparable to the other TROP2 ADC…. We have a few ADCs to choose from moving forward, so it's going to get more complicated but there are more options for our patients.
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