BCC 2025 | The future of ADCs for HR+ breast cancer and TNBC
Sara Tolaney, MD, MPH, Dana Farber Cancer Institute, Boston, MA, comments on the potential of antibody drug conjugates (ADCs) in HR+ and triple negative breast cancer (TNBC), highlighting their ability to deliver potent chemotherapy in a targeted manner. While ADCs have shown promise in the metastatic setting with the approval of four ADCs , further research is needed to determine their efficacy in the curative breast cancer space, particularly in identifying the right patient populations and optimizing treatment strategies. This interview took place at the 2025 St. Gallen International Breast Cancer Consensus Meeting in Vienna, Austria.
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Transcript
Yeah, so I think we’re really excited about antibody drug conjugates because it really represents a way to get targeted delivery of very potent chemotherapy. And we’ve seen multiple new antibody drug conjugates come into our field now with, in essence, four ADCs that are approved in the metastatic setting, including sacituzumab govitecan, datopotamab deruxtecan, trastuzumab deruxtecan, and now we even have sacituzumab tirumotecan, at least approved in China...
Yeah, so I think we’re really excited about antibody drug conjugates because it really represents a way to get targeted delivery of very potent chemotherapy. And we’ve seen multiple new antibody drug conjugates come into our field now with, in essence, four ADCs that are approved in the metastatic setting, including sacituzumab govitecan, datopotamab deruxtecan, trastuzumab deruxtecan, and now we even have sacituzumab tirumotecan, at least approved in China. So I think we’ve made a lot of headway, but the challenge is it’s figuring out how to move those drugs into the curative breast cancer space. And so I think there are lots of strategies to do that. We can think about using them before surgery, after surgery, in patients who have residual disease, or even in a pure adjuvant treatment setting. And so far we have seen some early work that has been done. Most of it has been done in the preoperative setting where we’ve seen some data to date, mostly smaller trials, where we’ve seen studies being done in the hormone receptor positive setting as well as in the triple negative setting. I think the challenge that we’ve seen so far is most of these trials have either used an ADC alone or used an ADC with a checkpoint inhibitor. And the pathologic complete response rates, I will say have been modest. They haven’t been, I think, home runs in breast cancer overall. And so I think some of the things we have to think about is who are the right patients to use ADCs in in the hormone receptor positive space. We probably should be picking patients who have chemosensitive disease, whereas much of the early work hasn’t really selected patients who are gonna be chemosensitive. I think we’re gonna have to better understand if we need to select patients based on target expression in the metastatic setting, it hasn’t mattered so much, but it may be different in the early disease space. And I think we’re gonna have to better understand that, particularly as we better develop quantitative assays to understand target expression. And then finally, I think it’s thinking about what the right way to utilize them is. Should we be giving ADC combinations? Should we be giving sequential ADCs? And so there are lots of trials ongoing that I think will help elucidate this, but I think a very exciting space.
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