Sufferers with localized, hormone receptor-positive, HER2-low breast most cancers handled with trastuzumab deruxtecan (T-DXd, Enhertu) within the neoadjuvant setting had an general response charge of 75 p.c within the absence of anastrozole and 63 p.c together with anastrozole, in keeping with outcomes from the part II TRIO-US B-12 TALENT trial introduced on the San Antonio Breast Most cancers Symposium, held December 6-10, 2022.
That is the primary report of neoadjuvant T-DXd for sufferers with hormone receptor-positive, HER2-low, localized breast most cancers. It may present the groundwork for future research with antibody-drug conjugates, together with T-DXd, for sufferers with early-stage breast most cancers.”
Aditya Bardia, MD, MPH, attending doctor at Mass Common Most cancers Middle and director of breast most cancers analysis and affiliate professor at Harvard Medical College
Sufferers with localized, high-risk breast most cancers are sometimes given chemotherapy earlier than present process surgical procedure. Nonetheless, when such tumors specific the estrogen receptor and/or the progesterone receptor, the pathological full response charge to neoadjuvant chemotherapy is lower than 5 p.c, necessitating new remedy choices, Bardia mentioned.
T-DXd is an antibody-drug conjugate that’s internalized into most cancers cells upon binding to HER2. As soon as inside, it releases a cytotoxic payload that causes DNA harm and kills the most cancers cell. It’s presently authorized by the U.S. Meals and Drug Administration (FDA) to deal with a number of forms of tumors that overexpress HER2, and it was lately authorized to deal with metastatic breast most cancers with low HER2 expression.
“Whereas T-DXd demonstrated spectacular efficacy in metastatic HER2-low breast most cancers, up to now, no trial has evaluated T-DXd in localized, early-stage, doubtlessly curable HER2-low breast most cancers, which led us to design this neoadjuvant scientific trial,” mentioned Sara Hurvitz, MD, medical director of the Scientific Analysis Unit at Jonsson Complete Most cancers Middle, a professor of medication within the Division of Hematology/Oncology on the College of California, Los Angeles, and co-author of the examine.
Bardia, Hurvitz, and colleagues performed the part II TRIO-US B-12 TALENT scientific trial to evaluate the protection and efficacy of T-DXd when used as a neoadjuvant remedy, both alone or together with the aromatase inhibitor anastrozole. On the time of first knowledge cutoff (10/05/2022), 17 sufferers had accomplished the deliberate eight cycles of T-DXd, and 16 sufferers had accomplished the deliberate six cycles of T-DXd plus anastrozole.
In keeping with Bardia, the first endpoint for the examine was a 5 p.c pathologic full response (pCR) charge, outlined as full tumor regression and no lymph node involvement on the time of surgical procedure. On the time of first knowledge cutoff, no sufferers had skilled a pCR within the mixture remedy arm, and one out of 19 sufferers (5.3 p.c) had skilled a pCR within the solo remedy arm.
As of the information cutoff, 33 sufferers had accomplished neoadjuvant remedy and undergone surgical procedure, seven sufferers have been awaiting surgical procedure, and 13 sufferers have been nonetheless present process T-DXd remedy. Among the many response-evaluable inhabitants, within the solo remedy arm, the general response charge was 75 p.c, together with 11 partial responses and one full response. Within the mixture remedy arm, the general response charge was 63 p.c, together with 10 partial responses and two full responses.
The most typical treatment-related adversarial occasions of grade 3 or increased have been hypokalemia, diarrhea, neutropenia, fatigue, headache, vomiting, dehydration, and nausea, every of which occurred in fewer than 6 p.c of sufferers. One affected person developed grade 2 interstitial lung illness, which resolved after remedy discontinuation.
Complete affected person numbers and efficacy knowledge are immature and might be up to date on the time of the assembly.
Hurvitz careworn that the scientific end result outcomes, together with pCR and general response charge, usually are not mature, as not all sufferers had scans or underwent surgical procedure by the point of information cutoff. General, the tolerability and general response knowledge have been encouraging and will warrant future research on T-DXd on this affected person inhabitants, Hurvitz mentioned.
“The examine demonstrated that T-DXd was comparatively protected in HER2-low, hormone receptor-positive, localized breast most cancers. It supplies translational framework for future research, together with mixture regimens within the neoadjuvant setting to additional enhance scientific outcomes,” Bardia mentioned.
Bardia, Hurvitz and colleagues intention to observe up on this work by analyzing potential biomarkers from tumor tissue and blood samples taken earlier than, throughout, and after remedy. Bardia hopes these biomarkers will assist researchers extra precisely assess HER2 standing, predict which tumors can have one of the best responses to T-DXd remedy, and illuminate potential mechanisms of T-DXd resistance.
Limitations of this examine embrace a small pattern measurement attribute of part II research, which didn’t permit for a proper comparability of the 2 remedy arms. Moreover, the first and secondary endpoints of this examine assessed response however didn’t consider long-term survival.
The examine was performed as an investigator-initiated examine by the Translational Analysis In Oncology (TRIO)-US community. Funding for this examine was offered by Daiichi Sankyo. Bardia serves as a advisor or advisory board member for Pfizer, Novartis, Genentech, Merck, Radius Well being, Immunomedics/Gilead Sciences, Sanofi, Daiichi Sankyo, AstraZeneca, and Eli Lilly and Firm. Bardia has acquired analysis funding from Genentech, Novartis, Pfizer, Merck, Sanofi, Radius Well being, Immunomedics/Gilead Sciences, Daiichi Sankyo, AstraZeneca, and Eli Lilly and Firm. Hurvitz has acquired a speaker honorarium from Daiichi Sankyo and analysis funding from Ambrx, Amgen, Arvinas, AstraZeneca, Bayer, Biomarin Pharmaceutical, Cascadian Therapeutics, CytomX Therapeutics, Daiichi Sankyo, Dantari, Dignitana, Genentech/Roche, G1 Therapeutics, Gilead Sciences, GlaxoSmithKline, Immunomedics, Eli Lilly, MacroGenics, Merrimack Prescription drugs, Novartis, OBI Pharma, Orinove, Pfizer, Phoenix Molecular Designs, Pieris Prescription drugs, Puma Biotechnology, Radius Well being, Sanofi, Seattle Genetics, and Zymeworks.