Clinical Scenario - Triple-Negative Breast Cancer

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.

Dr. Nunnery outlines the systematic approach beginning with PD-L1 status assessment and immunotherapy eligibility evaluation. For PD-L1 positive, immunotherapy-eligible patients, SG combined with pembrolizumab represents the preferred approach based on ASCENT-04 data.

For PD-L1 negative patients representing the majority, either Dato-DXd or SG monotherapy becomes appropriate, with selection based on side effect profiles, dosing schedules, patient life circumstances, and care goals through shared decision-making discussions.

The stable treated brain metastases don't significantly impact treatment selection, given encouraging central nervous system penetration data for ADCs. Both SG and Dato-DXd demonstrate some CNS activity, providing reassurance for use in patients with treated brain metastases while maintaining systemic disease control and preventing further CNS progression.

Ms. Davidson addresses common patient calls regarding nausea and diarrhea management, emphasizing symptom severity triage for home management versus clinic evaluation needs. Adherence to prophylactic anti-nausea regimens for three consistent days significantly reduces symptom burden, while diarrhea management involves immediate loperamide use with escalation protocols for severe cases.

Dr. Sunshine confirms identical ocular toxicity management approaches for Dato-DXd regardless of disease setting, though acknowledges the need for additional research comparing ocular outcomes between different patient populations.

The case illustrates treatment selection factors in triple-negative breast cancer and the importance of multidisciplinary support for optimal patient outcomes in this challenging disease setting, with the panel concluding by thanking participants and viewing audience for the comprehensive discussion on evolving treatment landscapes and multidisciplinary care strategies.