Sheraz Azhar, Medical Oncology SpR at the University Hospitals of Leicester NHS Trust and Founder of OncsCare, shared a post on LinkedIn:
“This FDA Approval feels genuinely practice changing.
The FDA approval of T-DXd + pertuzumab moves an ADC straight to the frontline. From a registrar’s perspective, this is a major shift in how we think about sequencing.
As a medical oncology registrar, this moment hits differently. We’ve trained with a fairly fixed mental model of HER2 sequencing – CLEOPATRA first, then T-DM1, then T-DXd. That framework is now being rewritten.
What stands out isn’t just the efficacy signal. It’s what this represents: a move away from upfront cytotoxic chemotherapy and for many patients the growing confidence in ADC-first strategies and a reminder that ‘lines of therapy’ are not static concepts, but evolving reflections of biology, data, and patient priorities.
In clinic, this matters. Patients increasingly ask why a treatment is recommended – not just what it is. Being able to offer a highly effective, chemo-free first-line option reframes those conversations around quality of life, durability, and long-term planning, not just response rates.
It also raises important questions for trainees:
How do we think about sequencing after early T-DXd exposure?
How do we balance enthusiasm with vigilance, particularly around ILD?
And how do we adapt our practice when regulatory approvals move faster than guidelines and national reimbursement?
From a registrar perspective, this approval reinforces why staying close to trial data and translational science matters. The treatment landscape we will inherit as consultants is not the one we trained in – and that’s a good thing for patients.
Now we wait for NICE – National Institute for Health and Care Excellence – but the direction of travel is clear.”
More posts featuring Sheraz Azhar.