Sequential ADCs in Breast Cancer: A Real-World Look

A real-world retrospective study examined how 2 drugs, trastuzumab deruxtecan (T-DXd; Enhertu) and sacituzumab govitecan (SG; Trodelvy), work when used one after the other in patients with HER2-low metastatic breast cancer. Researchers looked at patient data to see how long patients lived without their cancer progressing and how long they lived overall.

They found that patients generally did better with the first drug than the second, regardless of patient age, cancer location, or if other treatments were used in between. Patients with cancer that had spread to the brain responded worse to the first drug compared to those without brain cancer.

This study provides valuable information on how these drugs work together in real-world settings. Here, Laura Huppert, MD, assistant professor of medicine at the University of California San Francisco, discussed this study's findings.

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0:05 | In the hormone receptor-positive, HER2-low cohort, 43% of patients received sacituzumab govitecan prior to T-DXd, and 57% of patients received T-DXd prior to sacituzumab govitecan. In the triple-negative cohort, most patients received sacituzumab govitecan prior to T-DXd. In general, we found that the real-world progression-free survival was longer for the first ADC than the second ADC, regardless of the hormone receptor status and the sequence.

0:38 | Importantly, there were exceptions. There were some patients that had a shorter real-world [PFS] with a first ADC and a longer real-world [PFS] with a second ADC, which suggests that it is worth trying both ADCs since you might be lucky and have one of those patients that has a longer response with the second. We also looked at whether the use of an intervening therapy mattered. For example, if you did T-DXd first, whether you put a chemo[therapy] in the middle before sacituzumab govitecan or not, did that make a difference? we found that the use of an intervening therapy did not seem to affect outcomes.