The new standard for first-line HER2+ breast cancer, TDXD-pertuzumab, has superior efficacy. However, experts are questioning if treating until disease progression is optimal for all, suggesting a switch to maintenance therapy could better balance side effects and quality of life. The ideal duration remains an open question.
Data from the Optima trial shows the ProSigna (PAM50) gene signature can identify premenopausal ER+ breast cancer patients, even those with high nodal burden, who can safely forgo chemotherapy. For those with a low-risk score, adequate ovarian suppression alone provides sufficient benefit, marking a major step in treatment de-escalation.
After a triple-negative breast cancer patient progresses on a first-line TROP2 antibody-drug conjugate (ADC), experts advise against immediately sequencing another ADC. Due to suspected cross-resistance, the recommended strategy is to return to traditional chemotherapy agents like taxanes or carboplatin, which remain effective options, before considering another ADC in later lines.