Mei Wei, MD, an oncologist specializing in breast cancer at Huntsman Cancer Institute at the University of Utah, discusses advancements in breast cancer treatment, highlighting CDK4/6 inhibitors and antibody-drug conjugates as promising alternatives to traditional therapies.
The Denver Regional Institute for Value-Based Medicine® event included Mei Wei, MD, an oncologist specializing in breast cancer at Huntsman Cancer Institute at the University of Utah who contributed to the session “New Treatment Opportunities in HR+/HER2- Breast Cancer."
Wei spoke with The American Journal of Managed Care® to discuss significant improvements in progression-free survival (PFS) and overall survival (OS) in both nonmetastatic and metastatic settings. She focused on 2 FDA-approved antibody drug conjugates (ADCs): trastuzumab deruxtecan (T-DXd; Enhertu; Daiichi Sankyo/AstraZeneca) and sacituzumab govitecan (SG), which have both demonstrated improved PFS and OS in metastatic breast cancer.
This transcript has been lightly edited.
Transcript
Can you discuss some of the emerging therapies for HR+/HER2– breast cancer, such as CDK4/6 inhibitors, poly ADP-ribose polymerase (PARP) inhibitors, and antibody-drug conjugates?
I'm so excited we have so many treatment options we can offer our patients right now. In the adjuvant setting, now we can offer CDK4/6 inhibitors in addition to traditional aromatase inhibitors and tamoxifen, and in addition to the ovarian function suppressions.
Previously, we could only use abemaciclib, and now we have a new ribociclib. If a patient is unable to tolerate abemaciclib, we can try ribociclib. The ribociclib population is more broad, so if the patients are not eligible for abemaciclib, we can offer the patients ribociclib. This is a CDK4/6 inhibitor in the nonmetastatic setting.
In the metastatic setting, CDK4/6 inhibitors plus aromatase inhibitors as the first line of therapy has significantly improved the PFS and the overall survival as well. We have 3 CDK4/6 inhibitors we can offer to our patients. This is good because if a patient could not tolerate 1 CDK4/6 inhibitors, we can try different ones. We have many options for our patients in the metastatic setting right now.
The ADCs are another exciting field. We have 2 FDA-approved ADCs right now. One is T-DXd, another one is a sacituzumab govitecan, and we're expecting the third ADC, Dato-DXd, that could potentially could be approved. We're waiting for that news. So those are very exciting drugs.
T-DXd and Enhertu have both have been used in ER-positive, HER2-negative [HER2–] metastatic breast cancer. They not only improve the PFS, but also improve the overall survival. It's really hard to see any drugs improve overall survival in the metastatic setting, and they both achieved that primary end point. Those are very exciting drugs.
The third one, Dato-DXd [datopotamab deruxtecan], if it is approved, I think will potentially be a good option for our patients. The Dato-DXd is based on the TROPION-Breast01, a phase 3 study comparing the physicians’ choice among patients with ER-positive, HER2-low or HER2-negative metastatic breast cancer who have had aromatase inhibitor plus a CDK4/6 inhibitor, and also have had 1 line of chemotherapy. Dato-DXd significantly improved PFS compared with the physicians’ choice.
We don't have the overall survival data yet. However, based on the toxicity profile and the PFS data, this drug seems very well tolerated. It is beneficial in terms of improved PFS, and the treatment schedule is pretty benign as well. Treatment is every 3 weeks compared with saci [SG] that is day 1, day 8, every 21 days over 1 cycle.
Another benefit of this medication is we are not too worried about the grade 5 ILD [interstitial lung disease] with Dato-DXd compared with T-DXd. Just my personal preference. I think the Dato-DXd compared with saci has a benefit of a more convenient treatment schedule compared with T-DXd, [that] has less concern of ILD with much better tolerance. It would probably become my "favorite child" if the FDA approves it.
Patient Satisfaction Higher With Certain Breast Reconstruction Techniques
August 12th 2025Patient satisfaction was higher amongst patients who underwent a chest wall perforator flap reconstruction surgery as part of their breast cancer treatment when compared with other surgical techniques.
Read More
Hope on the Horizon for Underserved Patients With Multiple Myeloma: Joseph Mikhael, MD
August 12th 2025Explore the disparities in multiple myeloma treatment and how new initiatives aim to improve clinical trial participation among underrepresented patients during a conversation with Joseph Mikhael, MD, MEd, FRCPC, FACP, FASCO, chief medical officer of the International Myeloma Foundation.
Listen
Accessing pediatric dermatology care is challenging due to a shortage of specialists and general dermatologists' reluctance to treat children, but increasing their comfort level with seeing children could help bridge the gap, explained Elizabeth Garcia Creighton, of University of Colorado School of Medicine.
Read More
AI Meets Medicare: Inside CMS’s WISeR Model With Sanjay Doddamani, MD, MBA, Part 2
August 5th 2025In this second part of his interview with The American Journal of Managed Care®, Sanjay Doddamani, MD, MBA, a former senior advisor to CMMI and founder and CEO of Guidehealth, continues a dialogue on the future of value-based care and the promise—and limits—of AI-enabled innovation, reflecting on challenges like rising Medicare costs and patients’ growing financial burdens.
Read More
IgE Mediation in Pediatric Atopic Dermatitis, Concurrent Immune Disorders: Amy Paller, MD
August 4th 2025Amy Paller, MD, pediatric dermatologist and clinical researcher at Northwestern Medicine's Feinberg School of Medicine, discussed the potential impact of reducing immunoglobulin E (IgE) levels in pediatric patients with atopic dermatitis.
Read More