ESMO 2026 | T-DXd and pertuzumab redefines HER2+ metastatic breast cancer treatment

So for the first line treatment for HER2 POSITIVE metastated breast cancer, of course, we have, now it’s approved, trastuzumab, deruxicum plus pertuzumam. So because the primary endpoint demonstrated major improvement in progression-free survival. Furthermore, this morning we see that there’s activity on brain mets. The patients with brain mets at inclusion are doing very well because of the response, the control. So it’s, now we have two options as first lines. The THP-CLEOPATRA regimen with taxan, pertuzumab, trastuzumam, or trastusumab-deruxicum plus pertuzumab. So we have to discuss these two options according to patient profile. In my opinion, if the patient present brain metastasis, there is no doubt we will give the priority to trastumab plus pertusumam. But what the main question is, in Destiny O9 with TDXD, pertuzumab, patients were treated until progression of major toxicity. And we don’t know, I would say, the best duration, the duration of TDX-D we need. And the maintenance therapy was only with, when we stopped TDXZ, was only trastuzumab, pertusumab plus endocrine therapy in ER-POSITIVE disease. But we don’t know how we may translate the result of HER2CLIMB05 or PATINA to the TDX-D pertuzumab first line. We have no data for that. So I think next future we will evaluate that because TDXD is associated with side effects. It’s chemotherapy-like, nausea, vomiting, pneumopathy. So very important. A lot of work to do again.

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