ASCO 2025 | Treatment options for advanced breast cancer: navigating the complex world of ADCs
Paolo Tarantino, MD, Dana-Farber Cancer Institute, Boston, MA, comments on the growing number of available antibody-drug conjugates (ADCs) for breast cancer and the need for biomarkers to determine which ADC is most effective for each patient. Dr Tarantino emphasizes that the lack of clear guidelines for sequencing ADCs is a significant challenge, and developing biomarkers to predict response to specific ADCs is crucial to optimizing treatment outcomes and minimizing toxicities. This interview took place during the 2025 American Society of Clinical Oncology (ASCO) Meeting in Chicago, IL.
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Transcript
We are realizing that having several ADCs available is of course an opportunity. We can treat patients better, but in truth we have the challenge that we don’t know which ADC to use when. We don’t know how to sequence them. And ADCs are exploding. Like there’s more than 200 ADCs in clinical development. And so the question is when we’re going to have 5 or 6 or 10 ADCs available, which one should we use? And I think the only way to know this is to develop a biomarker that tells us this tumor would respond better to T-DXd or to DS-8201 or sacituzumab govitecan or enfortumab vedotin and this is why I think HER2 immunohistochemistry was not developed for predicting a disease and this is why T-DXd works very well in HER2 positive, HER2 low or to ultra low and even in HER2 zero now but with quantitative assays hopefully we’ll be able in the future to tell a patient that can derive the most benefit from a HER2 ADC or from a TROP2 ADC or something else and in that future we’ll be able to sequence ADCs better and treat patients better by sparing unnecessary toxicities...
We are realizing that having several ADCs available is of course an opportunity. We can treat patients better, but in truth we have the challenge that we don’t know which ADC to use when. We don’t know how to sequence them. And ADCs are exploding. Like there’s more than 200 ADCs in clinical development. And so the question is when we’re going to have 5 or 6 or 10 ADCs available, which one should we use? And I think the only way to know this is to develop a biomarker that tells us this tumor would respond better to T-DXd or to DS-8201 or sacituzumab govitecan or enfortumab vedotin and this is why I think HER2 immunohistochemistry was not developed for predicting a disease and this is why T-DXd works very well in HER2 positive, HER2 low or to ultra low and even in HER2 zero now but with quantitative assays hopefully we’ll be able in the future to tell a patient that can derive the most benefit from a HER2 ADC or from a TROP2 ADC or something else and in that future we’ll be able to sequence ADCs better and treat patients better by sparing unnecessary toxicities.
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