DESTINY-Breast04 Fulfills a Promise of Modern Cancer Therapy

DESTINY-Breast04 Fulfills a Promise of Modern Cancer Therapy

If oncologists can control patients’ cancer toxicity, patients can live their lives, and that’s the gift of modern cancer therapy, said Debra Patt, MD, PhD, MBA, executive vice president of public policy and initiatives strategies of Texas Oncology.

Here, Patt expands on his keynote address delivered at the 2022 Patient-Centered Oncology CareĀ® meeting, where he discussed how the Findings of the DESTINY-Breast04 Study can be applied to managed care.


What do the DESTINY-Breast04 study findings mean for managed care?

I am really excited about some of the new and novel therapies in cancer treatment. I think as a community oncologist we can not only have the goal of curing or chronically managing cancer as a chronic disease, but we can do that in communities where people, if we can manage their toxicity, go to work at their jobs, sit at the table, pick up their kids from soccer practice, and sleep next to their spouse, they get to live their life. And that really is the gift of modern cancer therapy. It is for this reason that I am very excited about the DESTINY-Breast04 trial looking at trastuzumab deruxtecan in patients with advanced HER2 low breast cancer. Around 80% of patients express HER2 low or HER2 amplified and could potentially benefit from HER2 blockade in advanced breast cancer.

What the DESTINY-Breast04 trial studied was, in patients with low HER2 expression, that, unlike chemotherapy, if you give this antibody-drug conjugate trastuzumab deruxtecan, you see an overall and progression-free survival benefit, either whether patients are hormone receptor positive or hormone receptor negative. This is really key for our breast cancer patient population, both because it’s an effective therapy: the overall response rates are very high, the hazard ratios for progression-free and overall survival are 0.5 and 0.6, so the benefits are really significant, but also the toxicity is low. . So some nausea that needs to be monitored, some alopecia that can occur, some toxicities of concern as we look at interstitial lung disease and cardiac dysfunction, but they do occur infrequently, and if we can monitor them, we can manage them effectively. .

I feel like this fulfills this promise of modern cancer therapy. It provides us with a non-toxic therapy that is highly effective in chronically controlling advanced breast cancer in our communities. And then patients can live this dream of modern cancer therapy where they can go to work, sleep next to their spouse, sit at the table and pick up their kids from football, because their cancer is under control and they are no substantial toxicity.

I’m really excited to talk to everyone about it, I think it’s important. There are some particular caveats about the trial that are important for people to be aware of, especially for payers. HER2-low screening is really important. There are ASCO/CAP guidelines for testing immunohistochemically positive or low HER2 in addition to fluorescence in situ hybridization. Understanding that algorithm and making sure that we’re not missing out on those low HER2 patient populations is really important.

In particular, when we do a bone biopsy, because especially with ER-positive breast cancer, it goes to the bone about 80% of the time, when you do a bone biopsy, there’s a chemical process of decalcification that can lead to false negative for further analysis. So you have to be able to suspect sometimes when patients may need additional testing and really think about how to go about it. That way, you can ensure that patients benefit from the right therapy.

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