Commenting on the DESTINY-Breast03 presentation at the 2022 San Antonio Breast Cancer Symposium, Neelima Vidula, MD, a medical oncologist at Mass General Cancer Center, said: “The results highlight the important survival differences of T-DXd [fam-trastuzumab deruxtecan-nxki] compared to T-DM1 [ado-trastuzumab emtansine]. The take-home message is that these data are compelling on survival with T-DXd vs T-DM1. We are already using T-DXd in the clinic, and this lends further support to our clinical practice.” 

Dr. Vidula continued: “The findings across subgroups were interesting, especially the potential benefit in patients treated with prior pertuzumab. Most patients are getting pertuzumab as part of first-line therapy for advanced disease. Also, there appears to be a potential effect of T-DXd in patients with brain metastasis at baseline, which needs to be explored further.”  

Neelima Vidula, MD

She added: “It is reassuring that the rate of interstitial lung disease is comparable to other studies with T-DXd in the metastatic setting. However, it is important to educate patients on pulmonary symptoms and monitor patients closely with computed tomography scans around every 2 months to identify pneumonitis and interstitial lung disease early. Also, physicians should assess for symptoms such as cough, fever, and shortness of breath, and conduct a thorough pulmonary examination. If there is clinical and/or radiographic evidence of pneumonitis, hold the drug and consider initiating a course of steroids. Working with pulmonology colleagues to identify and treat pneumonitis and interstitial lung disease can also help to reduce the severity of complications.” 

DISCLOSURE: Dr. Vidula has received institutional research funding from Merck, Novartis, Pfizer, and Radius; and has participated on advisory boards for Gilead Sciences, OncoSec, Aadi Bioscience, and Tera Sera.