How is T-DXd reshaping the treatment pathway for HER2-positive breast cancer?
Drs. Paolo Tarantino and Seth Wander discuss the rapidly evolving role of trastuzumab deruxtecan (T-DXd) across metastatic and early-stage HER2-positive breast cancer.
From the first-line DESTINY-Breast09 data to the neoadjuvant DESTINY-Breast11 and adjuvant DESTINY-Breast05 data, they explore the new opportunities and clinical questions around treatment selection, maintenance, toxicity management, and personalization.
Topics discussed:
• How DESTINY-Breast09 is changing first-line treatment for metastatic HER2-positive breast cancer
• T-DXd plus pertuzumab compared with the long-standing CLEOPATRA approach
• Why earlier use of T-DXd may improve disease control
• HER2 heterogeneity and the potential impact of T-DXd on CNS progression
• Selecting patients for first-line T-DXd plus pertuzumab
• Complete response, deep partial response, and time to maximal response
• When and how to consider transitioning from T-DXd to maintenance therapy
• PATINA and the role of palbociclib in ER-positive/HER2-positive maintenance
• HER2CLIMB-05 and adding tucatinib to trastuzumab and pertuzumab maintenance
• Personalizing maintenance according to hormone receptor status
• Treatment considerations after progression on first-line T-DXd
• PIK3CA mutations and outcomes with THP vs T-DXd plus pertuzumab
• Managing T-DXd-associated fatigue, nausea, cytopenias, alopecia, and ILD/pneumonitis
• Practical approaches to ILD screening, monitoring, treatment, and rechallenge
• DESTINY-Breast11 and incorporating T-DXd into neoadjuvant treatment
• DESTINY-Breast05 and T-DXd for residual disease after neoadjuvant therapy
• Treatment decisions when residual disease remains after neoadjuvant T-DXd
• The evolving role of CT monitoring in early-stage T-DXd treatment
• Future personalization using MRD, ctDNA, targeted therapies, and treatment escalation or de-escalation
▶️ Watch the full CHM Conversation for expert perspectives on integrating T-DXd across the evolving HER2-positive breast cancer treatment landscape.
#PaoloTarantino #SethWander #CHMConversations #HER2PositiveBreastCancer #BreastCancer #TDXd #TrastuzumabDeruxtecan #DESTINYBreast09 #DESTINYBreast11 #DESTINYBreast05 #CommunityHealthMedia
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