Naoto Ueno, MD, PhD, Discusses QOL With Trastuzumab Deruxtecan in HR+, HER2-Low Metastatic Breast Cancer

Treatment with fam-trastuzumab deruxtecan-nxki yielded promising patient-reported outcomes in patients with hormone receptor–positive, HER2-low metastatic breast cancer, according to Naoto Ueno, MD, PhD.

In an interview with CancerNetwork® during the 2022 European Society for Medical Oncology Congress (ESMO), Naoto Ueno, MD, PhD, of the Department of Breast Medical Oncology, Division of Cancer Medicine at the University of Texas, MD Anderson Cancer Center in Houston, discussed quality of life (QOL) findings phase the phase 3 DESTINY-Breast04 trial (NCT03734029) assessing the use of fam-trastuzumab deruxtecan-nxki (T-DXd; Enhertu) in patients with hormone receptor–positive, HER2-low metastatic breast cancer.

Ueno stated that treatment with T-DXd maintained QOL and global health scores compared with physician’s choice of treatment across every prespecified European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire-Core 30 subscale.


Patient-reported outcomes were a secondary end point [of DESTINY-Breast04]. PROs provide patients’ unique perspectives and is a balance between the treatment benefit vs the adverse effects of the treatment. The goal here is to understand the patient’s QOL. We assessed the survey using a 3 validated QOL assessments. From this study, what we have shown is that when patients undergo treatment with T-DXd compared with chemotherapy, they overall had reasonable compliance with treatment and the global health status score [highlighted] no difference between chemotherapy [and T-DXd]. They maintained high long-term QOL after receiving T-DXd. Now, if you look into the score subscales with more detail, there was a significant improvement in pain with T-DXd compared with the regular chemotherapy.

When you look at nausea and vomiting, there was a little bit more prominence with T-DXd in the first several cycles. But if you look into the long-term usage of T-DXd, it was stable. The nausea vomiting was a little bit stronger on T-DXd side but in the long run, it was stable and it didn’t really get worse. The big picture here is that we want to understand the time to definitive deterioration. This is measured by the scoring; if there’s more than a 10-point change, that is considered to be deterioration. That means a 10% change is considered significant. If you look at the time to definitive deterioration, it definitely favored T-DXd compared with chemotherapy. For T-DXd, the median time to deterioration was 16.4 months, and in the other arm it was approximately 6 months. Overall, the outcome favored the T-DXd arm.


Ueno NT, Jacot W, Yamashita T, et al. Patient-reported outcomes (PROs) from DESTINY-Breast04, a randomized phase 3 study of trastuzumab deruxtecan (T-DXd) vs treatment of physician’s choice (TPC) in patients (pts) with HER2-low metastatic breast cancer (MBC). Ann Oncol. 2022;33(suppl 7):217O. doi:10.1016/annonc/annonc1040