ESMO 2025 | Key insights on trastuzumab deruxtecan in high-risk early breast cancer
Nicholas McAndrew, MD, MSCE, UCLA Health, Santa Monica, CA, highlights the significance of the DESTINY-Breast05 (NCT04622319) data, which demonstrated the potential of trastuzumab deruxtecan in early stage breast cancer. The use of trastuzumab deruxtecan will likely be reserved for high-risk patients, and a new monitoring strategy will be necessary to mitigate potential toxicities such as pneumonitis. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
So, you know, aside from the data I mentioned on the NATALEE trial, I think that the data from DESTINY-Breast05 is certainly important and potentially practice-changing. I think that the biggest concern about bringing trastuzumab deruxtecan into the early stage curable setting is that we are still seeing fatal pneumonitis in small but, you know, some patients. And these are patients who, you know, may be cured of their disease...
So, you know, aside from the data I mentioned on the NATALEE trial, I think that the data from DESTINY-Breast05 is certainly important and potentially practice-changing. I think that the biggest concern about bringing trastuzumab deruxtecan into the early stage curable setting is that we are still seeing fatal pneumonitis in small but, you know, some patients. And these are patients who, you know, may be cured of their disease. So it’s always very, it makes us pause whenever we are thinking about giving someone a very toxic and potentially fatal therapy when it’s possible that they may never have their cancer return. I’m happy that that study was really limited to high-risk patients. And I can see practice changing where that’s going to be reserved and used clinically for high-risk patients. But I think that monitoring is going to be very, very important for standing chest CT. So it’s going to be a new monitoring kind of paradigm that we’re not used to in early stage disease. That’s going to be very, very important. But I think that I’m happy that we have this really powerful tool available for our patients, you know, but it’ll probably be for our highest risk patients.
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