Breast cancer, much progress with a new drug for inoperable or metastatic patients

The data of a large trial indicate that, in women with a specific subtype (that of HER2Low), a monoclonal antibody is able to improve the quantity and quality of life compared to current standard chemotherapy

Vera Martinella

It was the novelty of the year, the one considered most relevant by the over 27 thousand oncologists who participated in the annual convention of the American Society of Clinical Oncology, just finished in Chicago. So relevant that, during the presentation of the results during the plenary session of the congress (the one reserved for the most important news), the participants stood up for a standing ovation and the study was immediately published in the scientific journal New England Journal of Medicine. The results of the study DESTINY-Breast04 indicate, in fact, that in patients with a specific type of metastatic breast cancer (that at low levels of expression of HER2 or HER2Low) the new drug trastuzumab deruxtecan reduces the risk of disease progression or death by 50% compared with standard chemotherapy.

I study

To understand the scope of this experimentation it is good to remember that there are many different types of breast cancer and it is essential to know which histological and molecular subtype you are dealing with in order to choose, among the many available therapies, the most effective on the basis of the individual case. I study DESTINY-Breast04 (phase 3, last before final approval of a new medicine) evaluated the efficacy and safety of trastuzumab deruxtecan compared to physician-chosen chemotherapy (capecitabine, eribulin, gemcitabine, paclitaxel, or nab-paclitaxel) in 557 patients with unresectable or metastatic breast cancer (both hormone-positive and negative) with low levels of HER2, previously treated with one or two lines of chemotherapy. “The current standard of care for HER2-low patients is chemotherapy, but the results of this study change that because they show that using trastuzumab deruxtecan it is possible to keep the tumor under control for a longer time – explains Giuseppe Curigliano, Director of the Division for the Development of New Drugs and Innovative Therapies of the European Institute of Oncology in Milan -: compared to standard care doubles the time free from disease progression (the one during which the tumor remains stable, from 5 to 10 months) also improving the survival (from 17.5 months to 24) and the quality of life, given that they are registered fewer side effects “.

CHANGE YOUR CARE

With 55 thousand new cases diagnosed every year, breast cancer is the most frequent cancer in the entire Italian population: if, thanks to early diagnosis and effective therapies, today 87% of patients are alive at 5 years since the discovery of the disease, especially against the more aggressive forms and those that have reached the metastatic stage, innovative strategies are needed to extend the life of patients or to increase the number of recoveries. “Because of its remarkable aggression, until the nineties this type of cancer (the HER2-positive one) was a harbinger of really unfavorable prognosis, then several effective drugs arrived – he comments Saverio Cinieri, president of the Italian Medical Oncology Association (Aiom) -. The trastuzumab deruxtecan conjugated antibody is specifically designed to target the HER2 receptor and the results of this trial change clinical practice, because we now have the ability to treat patients with a conjugated antibody by reducing the unwanted consequences of chemo and improving both the time to disease control and the overall survival of women. It is therefore it is important that patients know what level of HER2 their cancer expresses, not only if it is positive or negative, especially since the HER2-low status can be determined using commonly available tests “.



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