Dr Basho on Treatment Considerations With ADCs in Breast Cancer

Reva K Basho, MD, senior director, the Women's Cancer Program, the Ellison Institute, Providence Specialty Medical Group, discusses the use of antibody-drug conjugates (ADCs) across the spectrum of breast cancer subtypes at the 2023 Bridging the Gaps in Breast Cancer meeting.

Basho says that oncologists are fortunate to be practicing in a time when numerous ADCs are entering the breast cancer armamentarium and improving patient outcomes. However, with the growing number of available agents, particularly those with similar payloads, it has become important to contemplate the sequencing of these treatments, she states. This becomes especially critical as these agents advance into earlier lines of therapy, encompassing curative and first-line metastatic disease, Basho explains. A key issue that has also arisen is how to navigate the treatment of patients transitioning from ADCs, she notes.

Delving into the underlying mechanisms of resistance is pivotal—whether it occurs at the antibody or payload level—and gaining a nuanced understanding is essential to effectively tailor the selection of agents for individual patients, Basho continues. The applicability of this inquiry extends across the diverse subtypes of breast cancer. Notably, ADCs are now being employed in the metastatic setting for patients with HER2-positive, triple-negative, hormone receptor–positive, and HER2-low disease, rendering this question relevant for a wide spectrum of patients with breast cancer, she emphasizes. Ideally, the implementation of ADCs as a method for chemotherapy delivery holds promise for accessing more potent payloads and adopting a targeted approach through antibody targeting, she says.

In considering the broader landscape, questions about sequencing become pertinent, and this extends to a broad population of patients, Basho expands. Through pan-tumor studies, insights have been gained on understanding how to navigate the complexities of ADC treatments that may potentially benefit a wide array of individuals, Basho concludes.