The doctors recommend using endocrine therapy-based options first-line when possible, before considering chemotherapy or antibody-drug conjugates, in order to preserve quality of life; they note exceptions could include patients with rapid progression or visceral crisis where immediate chemotherapy may be warranted, and that determining optimal sequencing requires understanding the safety profiles and efficacy data for the available regimens.
The doctors recommend using endocrine therapy-based options first-line when possible, before considering chemotherapy or antibody-drug conjugates, in order to preserve quality of life; they note exceptions could include patients with rapid progression or visceral crisis where immediate chemotherapy may be warranted, and that determining optimal sequencing requires understanding the safety profiles and efficacy data for the available regimens.
The TROPION-Breast01 trial studied the antibody-drug conjugate datopotamab deruxtecan (Dato-DXd) in previously treated HR+, HER2- breast cancer patients and showed improved progression-free survival to 7 months compared to 4.5 months with standard chemotherapy, with less high grade toxicity observed with Dato-DXd.
Laura Huppert, MD, and Yara Abdou, MD, discuss the CAPItello-291 trial which looked at the efficacy of capivasertib, a small molecule AKT inhibitor, in combination with fulvestrant for patients with estrogen receptor positive, HER2 negative advanced breast cancer who had progressed on prior endocrine therapy.
The EMERALD study showed improved progression-free survival with elacestrant compared to standard endocrine therapy in patients with ESR1 mutations who progressed on prior AI and CDK4/6 inhibitors, with the greatest benefit in those having longer duration of response to first-line therapy.