Paolo Tarantino, Clinical Research Fellow at Dana-Farber Cancer Institute, shared a post by Community Health Media on X, adding:
“CLEOPATRA did not test a fixed number of taxane cycles. We eventually landed on 6-8 cycles due to cumulative neuropathy.
DB09 did not test a fixed number of T-DXd cycles. However, the lack of neuropathy with T-DXd provided the opportunity for more prolonged administration. The opportunity to keep the tumor under the pressure of cytotoxic treatment for longer.
The effect of this can be seen in the DB09 PFS curves. They overlap for 4 months. They separate thereafter. Right after the taxane is stopped in the control arm, and maintenance is started, more patients start progressing. Progressions that are prevented in the T-DXd arm. And HER2+ disease progressions can be nasty.
So, how many cycles of T-DXd should we give? There’s no magic number. We should let the disease features and patient preferences guide us.
- Shorter duration for lower-risk disease. Longer duration if high-risk (recurrent, visceral, CNS, PI3K mut).
- Shorter duration for disease that rapidly achieve complete response. Longer duration for disease that shrinks less.
- Shorter duration for patients that experience bothersome side effects. Longer duration for patients that tolerate well.
Determining the duration of T-DXd really takes the whole art of medicine. We’re out of the one-size fits all era in HER2+ breast cancer.”
Quoting Community Health Media:
“Are we stopping T-DXd + pertuzumab too soon?
Drs. Paolo Tarantino and Seth Wander make a point that may surprise many oncologists. With T-DXd + pertuzumab, the median time to maximum tumor reduction is about 11 to 12 months, and some patients take even longer.
Many patients are labeled a partial response when they’re actually still on their way to something deeper.
That challenges how many have practiced for years. Their message is that we shouldn’t be so quick to pull the combination after an arbitrary number of induction cycles.
Full conversation here. When do you switch to maintenance with T-DXd + pertuzumab?”
Title: Right-sizing treatment for HER2-positive breast cancer: evolving algorithms across the disease continuum
Authors: Paolo Tarantino, Carmine Valenza, Elia Segui, Nancy U. Lin, Aleix Prat, Giuseppe Curigliano, Adrienne G. Waks, Sara M. Tolaney
You can also read:
CLEOPATRA Trial: The Study That Changed HER2-Positive Metastatic Breast Cancer Forever
