In which breast cancer presentation would you consider earlier treatment with T-DXd, given the similar absolute PFS benefits seen with T-DXd in the DESTINY-Breast06 trial and DESTINY-Breast04 trials?  

DESTINY-Breast06 was a head-to-head comparison, in the first-line chemotherapy setting for HR+ metastatic breast cancer, of T-DXd vs standard chemo (with 60% of patients receiving capecitabine and 40% of patients receiving taxane in the standard chemo arm). T-DXd had a significant PFS and ORR benefi...

For most patients with hormone receptor positive/HER2-low metastatic breast cancer, I recommend one line of chemotherapy, such as capecitabine which tends to have less side effects, prior to the use of T-DXd. I consider T-DXd administration prior to chemotherapy in patients with significant visceral...

Earlier treatment with T-DXd could be considered for: High-burden disease, such as rapidly progressing visceral metastases. HER2-low tumors with favorable biomarkers, such as high HER2 expression by IHC. Limited systemic options when prior chemotherapies have failed or are poorly tolerated. Pa...