Oncology Today with Dr Neil Love Antibody-Drug Conjugates for Breast Cancer — Year in Review Series on Relevant New Datasets and Advances
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Feb 28, 2026 
Dr Sara M Tolaney, a Dana-Farber breast cancer researcher, and Dr Hope S Rugo, a City of Hope clinical trial expert, review antibody-drug conjugate trial data and treatment choices. They compare ADC options for HER2-low, HER2-positive, and triple-negative disease. They discuss sequencing, toxicity tradeoffs, brain metastasis management, ILD risk, and combining ADCs with immunotherapy.
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TDXD Often Best First-Line For HER2 Positive
- TDXD has outperformed virtually every comparator across settings, making it a strong first-line option for many HER2-positive metastatic patients.
- Consider TDXD up front especially for aggressive disease and potential brain-metastasis prevention, but weigh ILD risk and nausea against benefit.
Switch To Maintenance After Maximal Response
- After achieving maximal response on TDXD plus pertuzumab, switch to a maintenance strategy rather than indefinite ADC exposure.
- Use endocrine therapy plus HP and palbociclib for ER+ and tucatinib plus HP for ER- as reasonable maintenance options.
Give PJP Prophylaxis When Steroids Are Used
- Prophylax patients on prolonged steroids to prevent PJP when treating brain mets with TDXD.
- Use TMP-SMX or atovaquone (for sulfa allergy) early; steroids given for brain radiotherapy likely drove PJP cases in DESTINY-Breast12.