Future breast cancer care: ESMO Breast Cancer 2024
Transcript: Underrated data: BMI-based chemotherapy dosing and trastuzumab deruxtecan for ILD
Professor Diana Lüftner
All transcripts are created from interview footage and directly reflect the content of the interview at the time. The content is that of the speaker and is not adjusted by Medthority.
Yeah, there are certainly data that are not earth-shaking, but they answer questions that you often have in the clinic. We have been discussing forever, whether we have to dose chemotherapy based on body surface, and body surface, of course, is increasing with weight and body mass index. And, of course, overweight people can, if you just reduce the dose, if you cut it, body surface of two square metres, for instance, could have less benefit. So what we have seen now for the first time, in terms of body mass index, is an analysis on an ADC on SG, trastuzumab deruxtecan, whether it works better or worse, depending on body mass index. And to make a very long story short, there is no indication that outcome varies with body mass index, or in other words, we obviously do not under dose patients with a higher body mass index, if we use the conventional dosing programmes for sacituzumab govitecan. And I would like to stay with the ADCs in this context. trastuzumab deruxtecan, because Hope Rugo presented a joint analysis on all the DESTINY, breast and lung, and gastric trials done with trastuzumab deruxtecan, and they took out all the patients with an ILD grade one interstitial lung disease. ILD-1 is clinically not apparent, but shown on imaging techniques or in the CT scan. And these patients, out of 193, who had ILD grade one, 45 were re-exposed to trastuzumab deruxtecan, one the ILD had recovered from one to zero. And among those, 15 out of 45 developed another ILD grade one or two, was treated with steroids or not. But there was no event of death, no fatal case. So at the bottom line, this was, if you have close surveillance, this was interpreted as being safe. And this is important if you have a patient who is profiting from this treatment, and develops ILD later in the treatment course, and then you are forced to take trastuzumab deruxtecan out of the treatment, and you wanna reintroduce it, because the patient is in the clinical benefit phase. This is, for me, something clinically very relevant, and we discussed this back and forth in our everyday care.
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