Ep. 52 Antibody Drug Conjugates Across the HER2 Spectrum: From HER2-Positive to Ultralow Breast Cancer with Dr. Sara Nunnery

Antibody-drug conjugates (ADCs) are expanding treatment options in breast cancer, but their use requires careful attention to toxicity. In this episode of the BackTable Tumor Board Podcast, Dr. Kate Baker and Dr. Sara Nunnery review the role of ADCs in HER2-positive disease and their growing application in HER2-low and HER2-ultralow metastatic settings.

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Timestamps

00:00 - Introduction
01:46 - How ADCs Work
08:40 - ILD Risk and Monitoring
13:46 - Next-Generation HER2 ADCs
24:14 - HER2-Low and Ultralow Disease
29:56 - Sequencing After Endocrine Therapy
33:42 - Future Targets and Bispecifics
38:08 - Wrap Up

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More about this episode

The discussion outlines ADC mechanisms and recent trial-driven shifts in clinical practice, with emphasis on interstitial lung disease (ILD) risk, monitoring, and patient counseling. They address practical considerations including patient selection, sequencing after endocrine therapy, and potential maintenance approaches. Additional topics include evolving pathology reporting, considerations for earlier-stage use in high-risk patients, and the development of next-generation HER2- and HER3-targeted ADCs, as well as bispecific therapies.

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Resources

DESTINY Breast 09
https://www.nejm.org/doi/full/10.1056/NEJMoa2508668

DESTINY Breast 05
https://www.nejm.org/doi/full/10.1056/NEJMoa2514661

DESTINY Breast 06
https://www.nejm.org/doi/abs/10.1056/NEJMoa2407086