Round table discussion: strategies for the treatment of HER2-positive advanced breast cancer in the rising age of antibody-drug conjugates.

Abstract

For HER2-positive breast cancer, with the widespread adoption of trastuzumab + pertuzumab as well as postoperative intensive treatments with antibody-drug conjugates (ADCs), such as trastuzumab emtansine (T-DM1), and tyrosine kinase inhibitors (TKIs), such as neratinib, in the (neo) adjuvant setting, it is difficult for the physicians to know what is the optimal strategy for the metastatic setting because of limited evidences from clinical trials. Trastuzumab deruxtecan (T-DXd), as a new generation of HER2-targeted ADC drugs, shows significant advantages in efficacy compared with the T-DM1 in patients previously treated with trastuzumab. How to make the strategies for stratification management of HER2-positive advanced breast cancer in the rising era of ADCs? How to evaluate the value of progression-free survival (PFS), overall survival (OS) and objective response rate (ORR) as efficacy indicators in clinical trials for HER2-positive metastatic breast cancer? What is the prospect of T-DXd in first-line therapy? Our panel of authorities considers these problems in a round-table discussion.