ESMO 2025 | Balancing the efficacy and toxicity of T-DXd in early stage breast cancer
Charles Geyer, MD, University of Pittsburgh Medical Center, Pittsburgh, PA, comments on the trade-offs associated with antibody drug conjugates (ADC), such as trastuzumab deruxtecan (T-DXd), in breast cancer. While they can offer improved outcomes, they also come with risks like interstitial lung disease, which must be carefully managed and reversed to ensure the benefits outweigh the drawbacks. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
You know the initially there’s the idea that well antibody drug conjugates aren’t chemotherapy like T-DM1 was so much milder than what we’d see T-DXd has GI toxicity we saw that but you can use strong anti-emetics to deal with that the real thing is is the interstitial lung disease and the reversibility, so it’s always gonna be that trade-off. The absolute improvement was about 9%, and strictly speaking, well, you improve your outcome by 9%, but if you have 9% lung toxicity, if you gain, well, only if the lung toxicity gets better...
You know the initially there’s the idea that well antibody drug conjugates aren’t chemotherapy like T-DM1 was so much milder than what we’d see T-DXd has GI toxicity we saw that but you can use strong anti-emetics to deal with that the real thing is is the interstitial lung disease and the reversibility, so it’s always gonna be that trade-off. The absolute improvement was about 9%, and strictly speaking, well, you improve your outcome by 9%, but if you have 9% lung toxicity, if you gain, well, only if the lung toxicity gets better. And that’s what we’re, and we know it has enough for this, but again, it’s moving it earlier. That’s the big question.
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