Optimizing ADC Supportive Care Prescribing and AE Management With Institutional Workflows
Panelists discuss how health care professionals use standardized antibody-drug conjugate (ADC) pathways to guide dosing, adverse effect (AE) management, and transitions. Protocols ensure monitoring, toxicity mitigation, and seamless shifts between therapies for optimal care.
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Monitoring Strategies for Managing ADC Toxicities in mBC
Panelists discuss how pharmacists should monitor neutropenia, diarrhea, and mucositis from sacituzumab govitecan (SG); interstitial lung disease (ILD) and neutropenia from trastuzumab deruxtecan (T-DXd); and neutropenia and ILD from datopotamab deruxtecan (Dato-DXd). Proactive management is essential for patient safety.
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Managing ADC Toxicities and Infusion Reactions With Supportive Care Strategies
Panelists discuss how antibody-drug conjugates (ADCs) often cause toxic adverse events (AEs). Supportive care includes antiemetics, corticosteroids, and growth factors. Infusion reactions are managed with premedication and slow titration.
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Practical Insights for Pharmacists on ADC Administration, Patient Experience, and Supportive Care
Panelists discuss how antibody-drug conjugates (ADCs) often show more diverse outcomes in real-world settings compared with clinical trials, with varying efficacy and adverse effect profiles. Key practical considerations for pharmacists include appropriate dosing based on patient factors, managing drug interactions, implementing premedication protocols to minimize adverse reactions, and providing comprehensive supportive care. Careful monitoring and individualized patient management are essential for optimal therapeutic outcomes.
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Personalizing ADC Therapy in mBC Based on Patient Characteristics and Prior Therapies
Panelists discuss how patient characteristics significantly impact antibody-drug conjugate (ADC) therapy selection, with key factors including the presence and location of brain metastases (due to blood-brain barrier penetration), organ function and comorbidities affecting toxicity risks, and prior treatment history that may influence both efficacy and safety. Treatment decisions require careful individualization.
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Emerging ADC Clinical Trial Evidence in Breast Cancer Treatment
Panelists discuss how emerging antibody-drug conjugates (ADCs) in metastatic breast cancer (mBC) treatment demonstrate innovation through optimized drug-to-antibody ratios, novel payloads, and targeted approaches to different breast cancer subtypes. Key trials explore combinations with established therapies and potential for improved tolerability profiles. Additional notable studies include comparative effectiveness research between approved ADCs and investigation of biomarker-driven patient selection strategies to maximize therapeutic benefit while minimizing adverse effects.
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Key Considerations for Oncology Pharmacists When Selecting and Sequencing ADC Therapies
Panelists discuss how when making antibody-drug conjugate (ADC) treatment decisions for patients with metastatic breast cancer (mBC), pharmacists primarily consider patient-specific factors such as biomarker status, prior therapies, disease burden, and comorbidities. ADCs are typically introduced after standard first-line treatments show inadequacy or in specific molecular subtypes that demonstrate strong responses to targeted therapy.
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Comparing Approved ADC Options in HER2-Negative and HER2-Low Breast Cancer
Panelists discuss how antibody-drug conjugates (ADCs) for breast cancer (BC) differ in their safety profiles, with trastuzumab deruxtecan (T-DXd) having notable interstitial lung disease risk, sacituzumab govitecan (SG) associated with neutropenia/diarrhea, and datopotamab deruxtecan (Dato-DXd) showing a relatively favorable safety profile but still requiring monitoring.
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Beyond HER2: Expanding the Biomarker Testing Landscape in Metastatic Breast Cancer
Panelists discuss how HER2 testing optimization requires multisite sampling and quantitative assessment methods to account for intratumoral heterogeneity. Beyond HER2, biomarkers such as PI3K mutations, hormone receptor status, and tumor mutational burden can guide therapy selection for metastatic breast cancer (mBC), enabling more personalized treatment approaches.
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How ADC Design Influences Efficacy and Safety
Panelists discuss how antibody-drug conjugates (ADCs) show varying efficacy and adverse event (AE) profiles based on their payload potency, linker stability, and drug-to-antibody ratio. Cleavable linkers enable targeted drug release but may increase toxicity, while noncleavable designs offer better stability. Payload selection impacts both therapeutic index and AEs, with more potent warheads requiring careful optimization of targeting and release kinetics.
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Transforming Breast Cancer Treatment Through ADC-Targeting Mechanisms
Panelists discuss how antibody-drug conjugates (ADCs) combine monoclonal antibodies with cytotoxic payloads, enabling precise targeting of breast cancer (BC) cells through specific antigen recognition. Upon binding, the ADC-antigen complex is internalized, releasing the toxic payload inside cancer cells while largely sparing healthy tissue. This targeted approach offers improved efficacy and reduces systemic toxicity compared with traditional chemotherapy's broad cytotoxic effects.
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Panelists discuss how the National Comprehensive Cancer Network (NCCN) and American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guidelines for HER2-negative breast cancer (BC) have evolved to recognize HER2-low (IHC 1+ or 2+/ISH-negative) and HER2-ultra low (IHC 0) as distinct categories. These classifications, particularly HER2-low, guide eligibility for targeted therapies such as trastuzumab deruxtecan, expanding treatment options beyond traditional chemotherapy for previously categorized HER2-negative patients.
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Key opinion leaders (KOLs) provide key takeaways on metastatic breast cancer and early breast cancer, emphasizing the enthusiasm surrounding recent advances in the field and the potential for improved patient outcomes.
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Bridging the Gap: Multidisciplinary Collaboration in Early Breast Cancer Care
The panelists share their concluding thoughts on the importance of collaboration between academic and community practices to achieve the best outcomes for their patients, which includes seeking second opinions and incorporating insights from tumor board discussions.
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Navigating Therapy Approval for Early Breast Cancer: An Operational Perspective
Medical experts discuss their perspectives on therapy approval and the significance of formulary inclusion, emphasizing the need to carefully consider both toxicities and benefits, which may ultimately lead to the operationalization of a drug in clinical practice.
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Alternative Treatments for eBC and mBC
Key opinion leaders (KOLs) discuss the use of CDK4/6 inhibitors in early breast cancer, specifically in patients who have undergone chemotherapy and surgery. They highlight the key factors that help determine which patients are most likely to benefit from receiving these medications.
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Balancing Clinical and Economic Factors in Early Breast Cancer Treatment
The panelists discuss the clinical and economic factors that influence treatment decisions for early breast cancer (eBC), as well as the differences between eBC and metastatic breast cancer (mBC) in terms of adverse event management protocols and strategies for optimizing patient adherence.
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Defining the Standard of Care for Early Breast Cancer Treatment
Heather Moore, BCOP, CPP, PharmD, discusses the importance of treatment for early breast cancer, highlighting the use of chemotherapy followed by endocrine therapy. She notes that CDK4/6 inhibitors are being added for higher-risk patients, and oral selective estrogen receptor degraders may also be used in advanced cases.
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Academic and Community Practice Collaboration in mBC Treatment
Frank Scimeca, PharmD, MBA, BCOP, discusses the crucial collaborative effort between academic and community practices in managing and monitoring patients receiving CDK4/6 inhibitors, emphasizing the importance of communication and coordination to ensure optimal patient care.
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Exploring Therapeutic Alternatives to CDK4/6 Inhibitors in Metastatic Breast Cancer
Heather Moore, BCOP, CPP, PharmD, discusses switching from CDK4/6 inhibitors to later lines of therapy, typically due to toxicities, to alleviate symptoms. She emphasizes the goal of finding a new therapy rather than abandoning treatment altogether, and notes that targeted therapy may be necessary in cases of disease progression.
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Navigating Financial Barriers: Cost-Saving Strategies and Patient Assistance Programs
Frank Scimeca, PharmD, MBA, BCOP, discusses strategies for implementing cost-saving measures and utilizing patient assistance programs to help patients access therapy, while emphasizing the importance of mitigating financial toxicities for patients.
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