Tejas Patil, Assistant Professor of Thoracic Oncology; Vice Head of Clinical Affairs, Division of Oncology, University of Colorado Anschutz, shared Mali Barbi‘s, Medical Oncologist at Northwell Health, post on X, adding:
“Everything in this post is directly relevant to lung cancer as well. SATEEN answers the value of using sequential ADCs with a topoisomerase payload.
The answer… There is minimal to no value in sequencing ADCs with the same payload.”
Quoting Mali Barbi’s post:
“Two prospective phase II trials at ESMO Breast Cancer 2026 just settled something the field has been debating retrospectively.
SATEEN (LBA4): saci+ trastuzumab after prior T-DXd in HER2+ MBC. ORR 3.7%. One response in 27 patients. Median PFS 2.3 months. Stopped for futility.
HER3_DXd: ORR 39% in ADC-naive HR+/HER2- disease. Prior TOPO1 ADC exposure wiped that out across every subtype.
Different antibody targets. Same collapse. Because resistance here is payload-driven, not antigen-driven. SN-38 and DXd are different molecules but the same mechanism. Abelman et al. (Clin Cancer Res 2025) showed acquired TOP1 mutations in 12.9% of patients at ADC progression median duration on the second TOPO1 ADC: 52 days versus 455 on the first.
Post-ADC trial design has to start from the payload up, not the target down.”
Other articles featuring Tejas Patil and Mali Barbi on OncoDaily.