ESMO 2025 | Optimizing ADCs in mBC: boosting efficacy & managing toxicity in earlier treatment lines
Sara Tolaney, MD, MPH, Dana-Farber Cancer Institute, Boston, MA, discusses the key research priorities for optimizing antibody-drug conjugates (ADCs) efficacy and managing toxicity as these agents move into earlier treatment lines for metastatic breast cancer, highlighting the need to balance risk and benefit in curative patients and the importance of biomarker selectors to determine which patients require ADC treatment. Dr Tolaney notes that the use of ADCs like Trastuzumab deruxtecan (T-DXd) in early stage breast cancer will require shifts in clinical practice, including monitoring for potential interstitial lung disease. This interview took place at the European Society for Medical Oncology (ESMO) 2025 Congress in Berlin, Germany.
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Transcript
As we are moving ADCs into the early breast cancer setting, it is really critical that we figure out how to optimize these drugs. One of the challenges, for example, with T-DXd is that it can cause potential interstitial lung disease, and that does require monitoring. And we’re not used to doing that in early stage breast cancer patients where they’re getting routine CT scans. But that is part of what is required when you use T-DXd...
As we are moving ADCs into the early breast cancer setting, it is really critical that we figure out how to optimize these drugs. One of the challenges, for example, with T-DXd is that it can cause potential interstitial lung disease, and that does require monitoring. And we’re not used to doing that in early stage breast cancer patients where they’re getting routine CT scans. But that is part of what is required when you use T-DXd. So I think it will be a bit of a shift in our general practices if T-DXd does start getting used for early stage breast cancer patients. But I think we also need to think about how much treatment patients need in the early stage setting. These are curative patients and we really do try to need to really carefully balance risk and benefit. And so hopefully we’ll get more and more studies that help us figure out how much treatment for which patient. I’d love to see biomarker selectors to help us know which patients really need an ADC or not. And so hopefully more to come on that.
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