Dr. Abi Siva & Dr. Carey Anders - DESTINY-Breast05, DESTINY- Breast11 and T-DXd Integration

How is T-DXd reshaping treatment for patients with early-stage HER2-positive breast cancer?

Dr. Abi Siva and Dr. Carey Anders discuss the evolving role of T-DXd across the treatment continuum, including the latest data from DESTINY-Breast11 and DESTINY-Breast05. The conversation explores how these studies are influencing neoadjuvant and adjuvant treatment strategies, patient selection, toxicity management, and future sequencing decisions.

The experts examine key clinical questions surrounding pCR, residual disease management, ILD monitoring, radiation considerations, treatment duration, recurrence after T-DXd exposure, and how clinicians may approach increasingly complex treatment decisions as T-DXd moves into earlier-stage disease.

Topics discussed include:

• DESTINY-Breast11 and neoadjuvant T-DXd
• DESTINY-Breast05 and residual disease management
• Pathologic complete response (pCR) outcomes
• T-DXd versus T-DM1 in the adjuvant setting
• Patient selection for neoadjuvant therapy
• ILD monitoring and management strategies
• Radiation pneumonitis versus drug-related ILD
• Treatment duration considerations
• ctDNA and future biomarker strategies
• CNS recurrence considerations
• Recurrence after prior T-DXd exposure
• Sequencing therapies in HER2-positive breast cancer
• Community versus academic practice considerations
• Future directions in HER2-positive disease

As T-DXd continues to move earlier in treatment, clinicians must balance maximizing efficacy with minimizing toxicity. This discussion highlights the practical considerations that may shape the future standard of care for HER2-positive breast cancer.

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