Innovations in Breast Cancer Treatment With Dr Dawn Klemow

Recent innovations in breast cancer include new findings on financial outcomes, the use of antibody drug conjugates, and combining targeted treatments, explains Dawn Klemow, MD, assistant clinical professor, The University of Texas Southwestern Medical Center.

Klemow is one of the panelists who will present on these research topics at the Institute for Value-Based Medicine® event, "Evaluating Value in Cancer Care: Dallas."

This transcript was lightly edited for clarity.

Transcript

When evaluating new treatments for breast cancer, what markers of success beyond traditional end points help determine their impact on patient outcomes and value in care?

Well, of course, progression-free survival and overall survival are still the gold standards of knowing how well a treatment is going to help these women, but there are other factors to consider. We need to look at treatments that have less toxicity, better ease of administration, require less monitoring, are affordable. I think those aspects of care are also very important when evaluating how well a treatment is going to help women.

Antibody drug conjugates have become a critical tool in breast cancer treatment. How do you prioritize targeted therapies in HER2-low or ultralow breast cancer, especially when multiple options are available?

The DESTINY-04 [DESTINY-Breast04; NCT03734029] trial first came out looking at the benefit of antibody drug conjugates in HER2-low disease, showing basically a doubling of progression-free survival over doctors’ chemotherapy choice, and then more recently, DESTINY-06 [DESTINY-Breast06; NCT04494425] showing that there's an equal benefit in HER2-ultralow. The issue with HER2-ultralow is still we have to get our pathologist to define it for us, so we know which patients would benefit from drugs like Enhertu [fam-trastuzumab - deruxtecan-nxki; Daiichi-Sankyo/AstraZeneca]. As far as prioritizing, for me, if a patient has triple-negative disease that’s ultralow, I'll usually use Trodelvy [sacituzumab govitecan-hziy; Gilead]. I think there's more data with Trodelvy for triple-negative, but for women who are endocrine sensitive, I will use Enhertu.

What emerging areas of research in metastatic breast cancer do you see as most likely to advance personalized treatment strategies, and how can providers prepare to integrate these advancements?

I think the advancements are really going to be in combining targeted treatments; adding CDK4/6 inhibitors to HER2-positive disease. We just had a positive trial showing that there's a benefit to adding Ibrance [palbociclib; Novartis] with HER2-targeted treatment. I think the way things are going is looking at combinations of unique molecules to better perform than, again, standard chemotherapy or hormonal therapies that we've traditionally used. I think that's going to be the wave of the future, and it's going to require oncologists to have a very good understanding of next-generation sequencing and the information that these tests can provide.