The rise of innovative therapies in breast cancer treatment

The Denver Regional Institute for Value-Based Medicine® event will feature Mei Wei, MD, a breast cancer oncologist at the University of Utah Huntsman Cancer Institute, who will discuss “New Treatment Opportunities in HR+/HER2- Breast Cancer.” contributed to the session.

I talked to Wei American Journal of Managed Care® We discuss the significant improvements in progression-free survival (PFS) and overall survival (OS) in both non-metastatic and metastatic settings. She focused on two FDA-approved antibody-drug conjugates (ADCs), trastuzumab deruxtecan (T-DXd, Enhertu, Daiichi Sankyo/AstraZeneca) and sacituzumab govitecan (SG). These all demonstrate improved PFS and OS in metastatic breast cancer.

This transcript has been lightly edited.

transcript

Can you explain some of the new treatments for HR+/HER2- breast cancer, such as CDK4/6 inhibitors, poly ADP ribose polymerase (PARP) inhibitors, and antibody-drug conjugates?

I am very excited about the many treatment options we now have available to our patients. In the adjuvant setting, in addition to traditional aromatase inhibitors and tamoxifen, we can now offer CDK4/6 inhibitors in addition to ovarian function suppression.

Previously only abemaciclib was available, but now the new ribociclib is available. If patients cannot tolerate abemaciclib, they can try ribociclib. Ribociclib has a broader population, so if a patient is not eligible for abemaciclib, they can be offered ribociclib. This is a CDK4/6 inhibitor in the non-metastatic setting.

In metastatic disease, the combination of CDK4/6 inhibitors and aromatase inhibitors as first-line therapy significantly improved PFS and overall survival. We have three types of CDK4/6 inhibitors available to our patients. This is good because if a patient cannot tolerate one CDK4/6 inhibitor, another can be tried. There are currently many options for patients with metastases.

ADCs are also an interesting area. There are currently two FDA-approved ADCs. One is T-DXd, the other is sacituzumab govitecan, and we are hopeful that a third ADC, Dato-DXd, may be approved. We are waiting for the news. So these are very interesting drugs.

Both T-DXd and Enhertu are used in ER-positive, HER2-negative patients. [HER2–] Metastatic breast cancer. These not only improve PFS but also overall survival. It is very difficult to identify drugs that improve overall survival in the metastatic setting, and both drugs met their primary endpoints. It's a very stimulating drug.

Third one, Dato-DXd [datopotamab deruxtecan]If approved, I think it could be a good option for patients. Dato-DXd is TROPION-Breast 01a phase 3 study comparing physician choice in patients with ER-positive, HER2-low, or HER2-negative metastatic breast cancer who received combination therapy with an aromatase inhibitor and CDK4/6 inhibitor plus one type of chemotherapy. . Dato-DXd significantly improved PFS compared to physician's choice.

Overall survival data are not yet available. However, based on the toxicity profile and PFS data, the drug appears to be very well tolerated. It is beneficial in terms of improved PFS and the treatment schedule is also very good. Treatment is every 3 weeks compared to saci [SG] In other words, days 1 and 8 constitute one cycle every 21 days.

Another advantage of this drug is that you don't have to worry too much about grade 5 ILD. [interstitial lung disease] Comparison of Dato-DXd and T-DXd. It's just my personal preference. I think Dato-DXd compared to Saci has the advantage of a more convenient treatment schedule compared to T-DXd. [that] It is much more tolerant, so ILD is less of a concern. If FDA approves it, it will probably become my “favorite baby.”