Sergio Cifuentes Canaval, Medical Oncologist at Las Américas Auna Clinic, shared a post on LinkedIn:
“DESTINY-Breast11: Redefining neoadjuvant therapy in HER2-positive early breast cancer — but raising important questions.
The DB-11 trial compared trastuzumab deruxtecan (T-DXd) ± THP versus ddAC-THP in patients with high-risk, HER2-positive early breast cancer.
Results showed a higher pathologic complete response (pCR) rate with T-DXd-THP (67.3% vs 56.3%, p=0.003), an early favorable event-free survival trend (HR 0.56), and a better safety profile, with lower rates of left ventricular dysfunction (1.9% vs 9.0%) and comparable ILD rates (4.4% vs 5.1%).
However, a deeper look reveals several key questions:
- The absolute pCR gain (~11%) is modest compared with TRAIN-2, an anthracycline-free regimen that achieved similar pCR (~68%).
- All patients received 8 cycles of T-DXd-THP, representing longer treatment exposure and increased cost.
- Whether this improvement in pCR will translate into long-term survival benefits (EFS or OS) remains uncertain.
Beyond efficacy, we must now define who truly benefits from such an intensified regimen. Molecular tools like HER2Dx may help tailor therapy, identifying those most likely to benefit while avoiding overtreatment.
In Latin America, discussions around access, cost, and equity will be essential. The introduction of ADCs into early-stage disease is transformative, but their integration must be thoughtful and sustainable.
The future of HER2-positive breast cancer is undoubtedly ADC-driven — but precision, not intensification, should guide our next steps.”
More from Sergio Cifuentes Canaval on OncoDaily.
