Antibody–drug conjugates in metastatic breast cancer

Abstract

Antibody–drug conjugates (ADCs) are therapeutics which have become a relevant option in the treatment of metastatic breast cancer (mBC) in every subtype. The combination of targeted therapy with a cytotoxic effect demonstrated remarkable benefits compared to conventional chemotherapy in advanced therapy lines. In addition, ADCs generally show favorable toxicity profiles with improved quality of life. In hormone receptor (HR)-positive human epidermal growth factor receptor 2 (HER2)-negative mBC, ADCs should be used after exhausting endocrine-based therapy. While sacituzumab govitecan can be used in all patients with HR+ HER2 mBC, the use of trastuzumab deruxtecan is limited to those with low HER2 expression. For the triple-negative mBC, sacituzumab govitecan is recommended after two lines of systemic therapy. In HER2-positive mBC, the combination of classic chemotherapy and HER2-directed antibody therapy with trastuzumab and pertuzumab is standard in first-line setting. In second line, trastuzumab deruxtecan is recommended in the guidelines.