Rebecca Shatsky/LinkedIn
May 25, 2025, 05:47
Rebecca Shatsky: Why We Need 1st Line ADC in Metastatic TNBC
Rebecca Shatsky, Associate Professor of Medicine at UC San Diego Health, shared a post on X:
“On why we need 1st line ADC in mTNBC: As someone who treats this disease all day long, it’s high time for a change and for Oncs to start thinking carefully about their choice of therapy here because mTNBC is life and death immediately for treatment failure/non response.
In de novo metastatic disease a taxane or carbo/gem (+/- pembro) may be fine. Chance of response is decent (though not as high as we need).
In relapsed mTNBC however, you have HIGHLY resistant disease already. In the Keynote 522 era these patients have already received Carbo, Taxol, pembro and AC. That’s a lot of drugs. And despite this we didnt kill those nasty CTCs.
Response rate to something like a (repeat) taxane or carbo/gem post Keynote are loooow and in this disease 1 line of non-response can me death.
mTNBC takes no prisoners. It is a brutal and ruthless foe and we have no room for treatment failure. To keep a person living with it we need effective therapy and we need therapy that crosses the blood brain barrier, which ADCs do.
With mTNBC brain mets and leptomeningeal development are often inevitable. CNS disease is a huge cause of death in this disease and a serious unmet need. We need therapy that prevents and or slows the development of disease in the brain.
To finish, in real, aggressive mTNBC (not the grade 2, older patient, more indolent version, I’m talking your typical 35 yo with the disease) Capecitabine is pretty useless. It really doesn’t work. Ask any mTNBC expert this. We don’t use this in that kind of disease.”
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