The role of trastuzumab deruxtecan (T-DXd) in HER2-low metastatic breast cancer treatment

We read the article entitled “ESMO Expert Consensus Statements (ECS) on the definition, diagnosis, and management of HER2-low breast cancer” 1 Tarantino P. Viale G. Press M.F. et al. ESMO Expert Consensus Statements (ECS) on the definition, diagnosis, and management of HER2-low breast cancer. Ann Oncol. 2023; 34: 645-659https://doi.org/10.1016/j.annonc.2023.05.008 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar with great interest. In this ESMO ECS 1 Tarantino P. Viale G. Press M.F. et al. ESMO Expert Consensus Statements (ECS) on the definition, diagnosis, and management of HER2-low breast cancer. Ann Oncol. 2023; 34: 645-659https://doi.org/10.1016/j.annonc.2023.05.008 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar , the best role for trastuzumab deruxtecan (T-DXd) in the treatment of HER2-low metastatic triple-negative breast cancer (TNBC) was discussed. T-DXd is recommended to be used after sacituzumab govitecan (SG); the reason is that the current evidence for SG in the phase 3 ASCENT trial 2 Bardia A. Hurvitz S.A. Tolaney S.M. et al. Sacituzumab Govitecan in Metastatic Triple-Negative Breast Cancer. N Engl J Med. 2021; 384: 1529-1541 Crossref PubMed Scopus (362) Google Scholar (N=529) was thought to be more robust than that for T-DXd in the Destiny Breast 04 clinical (DB-04) trial (N=63) 3 Modi S. Jacot W. Yamashita T. et al. Trastuzumab Deruxtecan in Previously Treated HER2-Low Advanced Breast Cancer. N Engl J Med. 2022; 387: 9-20 Crossref PubMed Google Scholar . ESMO expert consensus statements (ECS) on the definition, diagnosis, and management of HER2-low breast cancerAnnals of OncologyVol. 34Issue 8PreviewHuman epidermal growth factor receptor 2 (HER2)-low breast cancer has recently emerged as a targetable subset of breast tumors, based on the evidence from clinical trials of novel anti-HER2 antibody–drug conjugates. This evolution has raised several biological and clinical questions, warranting the establishment of consensus to optimally treat patients with HER2-low breast tumors. Between 2022 and 2023, the European Society for Medical Oncology (ESMO) held a virtual consensus-building process focused on HER2-low breast cancer. Full-Text PDF Trastuzumab deruxtecan (T-DXd) in HER2-low metastatic breast cancer treatmentAnnals of OncologyPreviewWe are grateful with Wei et al1 for their comments on our manuscript reporting the ESMO Expert Consensus Statements (ECS) on HER2-low breast cancer2. The authors argue that, based on the inclusion criteria of the ASCENT3 and DESTINY-Breast044 phase 3 trials, trastuzumab deruxtecan (T-DXd) should be prioritized over sacituzumab govitecan (SG) as second-line treatment for patients with HER2-low metastatic triple-negative breast cancer (mTNBC). Although we agree that T-DXd represents an important treatment option for this population of patients, we believe that the currently available data supports utilizing SG first. Full-Text PDF