Sara Hurvitz, MD, on the Benefit of Second-Line T-DXd in Subgroups of HER2+ Breast Cancer

Approval Alert | <b>Trastuzumab Deruxtecan for HER2-Positive Breast Cancer</b>

Sara Hurvitz, MD, spoke which patients would benefit most from fam-trastuzumab deruxtecan and what the next research steps will be.

Sara Hurvitz, MD, associate professor at the David Geffen School of Medicine, medical director of the Johnson Comprehensive Cancer Center Clinical Research Unit, co-director of the Santa-Monica- University of California Los Angeles (UCLA) Outpatient Oncology Practices, and director of the Breast Cancer Clinical Trials Program at the University of California Los Angeles, spoke with CancerNetwork® on future research efforts with fam-trastuzumab deruxtecan (T-DXd; Enhertu) and results from a subgroup analysis of the phase 3 DESTINEY-Breast03 trial (NCT03529110) in patients with unresectable or metastatic HER2-positive breast cancer.


Any patient with HER2-positive breast cancer appears to benefit from this therapy. The subgroup analysis does not indicate that there is a type of patient who wouldn’t benefit from T-Dxd compared with T-DM1. Regardless of whether or not they have visceral disease, whether or not they’ve received prior pertuzumab [Perjeta], if the hormone receptors are co-expressed, or if they have a history of brain metastases, all these groups appear to benefit from T-DXd compared with T-DM1.

The natural next step for evaluating T-DXd is to look at it in the first-line setting in patients who have not yet received therapy for metastatic disease. There’s an ongoing clinical trial [NCT05113251] looking at T-DXd compared with [docetaxel, trastuzumab, and pertuzumab] which is the standard option for patients right now based on the [phase 3] CLEOPATRA trial [NCT00567190]. Studies are also ongoing looking T-DXd in the adjuvant setting or curative setting, comparing T-DXd to T-DM1 [with] type of clinical trial design [similar to the phase 3 KATHERINE trial; NCT01772472]. We're going to very shortly in the coming next couple of years see a lot more data regarding this agent and potentially see T-DXd move up into earlier line settings.