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Safety of ADCs in MBC: Module

CME

Optimizing Outcomes and Quality of Life for Patients With Advanced Breast Cancer Through Effective Management of ADC-Associated Toxicities

Physicians: Maximum of 0.75 AMA PRA Category 1 Credit™

Released: February 07, 2024

Expiration: February 06, 2025

Komal Jhaveri
Komal Jhaveri, MD, FACP
CME/CE Information

Activity

Progress
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Course Completed

Introduction

In this module, Komal Jhaveri, MD, FACP, provides clinical insights into strategies for achieving optimal outcomes and significantly improving quality of life for patients receiving treatment with antibody–drug conjugates (ADCs) for previously treated advanced breast cancer.

The key points discussed in this module are illustrated with thumbnails from the accompanying downloadable PowerPoint slideset, which can be found here or downloaded by clicking any of the slide thumbnails alongside the expert commentary.

Clinical Care Options plans to measure the educational impact of this activity. A few questions will be asked twice: once at the beginning of the activity and then again after the discussion that informs the best choice. Your responses will be aggregated for analysis, and your specific responses will not be shared.

Before continuing with this educational activity, please take a moment to answer the following questions.

For those providing patient care, how many patients with breast cancer do you provide care for in a typical month?

A 49-year-old woman with a history of T2N0M0 grade 3 invasive ductal carcinoma of the left breast that is hormone receptor (HR) negative/HER2 negative (IHC 1+) receives neoadjuvant dose-dense doxorubicin and cyclophosphamide followed by paclitaxel with residual disease in the breast at surgery. She then receives adjuvant whole-breast radiation and 6 months of capecitabine; 16 months later, she develops metastatic disease involving the lung that is HR-negative/HER2 negative (IHC 1+); PD-L1 combined positive score (CPS) is 20. For her metastatic disease, she receives gemcitabine, carboplatin, and pembrolizumab and achieves a partial response, which unfortunately is followed by disease progression. At the time of progression, she receives trastuzumab deruxtecan (T-DXd) based on her HER2-low status. On her second restaging using high-resolution CT, scattered ground glass opacities are reported in both lungs. She is asymptomatic and has normal vital signs, including oxygen saturation of 98%. With the involvement of a pulmonologist, she is diagnosed with grade 1 interstitial lung disease (ILD).

At this time, what would you recommend for this patient with asymptomatic (grade 1) ILD?

A 52-year-old woman diagnosed 2 years ago with stage III triple-negative breast cancer in the left breast receives adjuvant chemotherapy. Follow-up imaging shows uptake in the right breast and metastatic lesions in the lung and liver. Tissue biopsy reveals BRCA1/2-negative metastatic breast cancer (PD-L1 CPS ≥10). She receives pembrolizumab plus chemotherapy and achieves a clinical response, and treatment is well tolerated. At a follow-up visit 11 months after starting pembrolizumab plus chemotherapy, imaging shows disease progression in the lung. She then receives sacituzumab govitecan (SG) and has been doing well with treatment. However, when she presents for cycle 6 Day 8 treatment, her absolute neutrophil count (ANC) is 850/mm3 (grade 3). She has been afebrile and feels well.

At this time, which of the following management approaches would you recommend for this patient?

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