Around the Practice: Multidisciplinary Perspectives in HR-Positive, HER2-Negative Metastatic Breast Cancer and Triple-Negative Breast Cancer

Experts unpack new antibody-drug conjugate trial data, sequencing choices, and toxicity management reshaping metastatic breast cancer care.

New ADC trial data reshapes metastatic breast cancer care: why OS differs, where T-DXd fits, and SG’s frontline gains in TNBC.

Dr. Nunnery discusses ASCENT-07, which moved SG earlier in the treatment sequence for HR-positive disease, allowing patients progressing on endocrine therapy to receive the ADC immediately rather than requiring intervening chemotherapy. Surprisingly, this frontline comparison against standard chemotherapy yielded negative results without statistically significant PFS improvement.

Dr. Nunnery describes TROPION-Breast02 studying Dato-DXd in frontline patients with metastatic TNBC for patients ineligible for immunotherapy, similar to ASCENT-03 design but with important differences in eligibility criteria.

Dr. Sunshine provides ophthalmologic perspective on Dato-DXd's unique ocular surface events, representing a new toxicity profile for breast oncology practitioners. The management approach begins with baseline patient education and ophthalmologic examination, establishing foundation for both patient awareness and professional monitoring.

Dr. Iyengar addresses common patient fears about vision loss, noting this represents a primary concern when discussing ocular toxicity. Dr. Sunshine provides reassurance that these represent reversible changes with appropriate monitoring and early intervention, emphasizing the importance of early detection through regular examinations.

Four experts discussed how new breast cancer ADC trial results guide treatment sequencing, as well as practical tips for managing Dato-DXd dry eye and other adverse effects.

The panel reviews a 58-year-old patient with HR-positive, HER2-negative metastatic breast cancer progressing after endocrine therapy plus CDK4/6 inhibitor treatment. The patient has hepatic and bone metastases with radiographic and symptomatic progression, ECOG performance status 1, controlled hypertension, and mild dry eye syndrome. She prioritizes maintaining professional activity and independence.

The panel discusses a 52-year-old patient with metastatic TNBC including lung lesions and previously treated stable brain metastases, presenting for first-line treatment recommendations.