Antibody-Drug Conjugates and HER2 Guidelines Are Reshaping Breast Cancer Treatment

In this interview with Pharmacy Times, Allison Reed, PharmD, BCPS, BCOP, Hematology/Oncology Clinical Pharmacy Specialist at The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, discusses the evolving breast cancer treatment landscape as antibody-drug conjugates move into earlier lines of therapy. Reed anticipates that these agents will reduce reliance on traditional cytotoxic chemotherapy while potentially improving outcomes and treatment experiences for patients. She highlights emerging HER2-directed data from DESTINY-Breast05, DESTINY-Breast11, DESTINY-Breast12, PATINA, and NeoCARHP as developments that may significantly affect early-stage and metastatic breast cancer care.

Pharmacy Times: With several antibody-drug conjugates moving into earlier lines of therapy, how do you see the treatment landscape for breast cancer evolving over the next few years?

Allison Reed, PharmD, BCPS, BCOP: That's a great question. Over the next few years, I anticipate using less and less cytotoxic chemotherapy, which is going to be really great for our patients because we know that they respond better to antibody drug conjugates.

Pharmacy Times: What recent breast cancer data or guideline updates do you think will have the biggest impact on clinical practice for oncology pharmacists?

Reed: Another good question. I think that it's really going to be the HER2 guidelines. Things have just exploded over the past year with the data from DESTINY-Breast05, DESTINY-Breast11, DESTINY-Breast12, and now we also have the PATINA and NeoCARHP trials. It's really changing both the early stage and the metastatic settings.

Pharmacy Times: As treatment options become increasingly biomarker-driven, what role do oncology pharmacists play in helping ensure patients receive the most appropriate therapy?

Reed: We’re really going to have to know a lot about sequencing. We’re going to need to know more about how to manage side effects in these patients so that we can keep them on treatment longer instead of having to discontinue treatment due to potential side effects. We also need to know what the inclusion criteria were for the trials. A lot of that can be hidden in the supplements or protocols, and it’s really going to be important for us to know that so we can say, ‘Well, this patient does actually qualify because of this little criterion that they hid in the protocol instead of publishing it in the full trial.