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Perez J, Garrigós L, Gion M, Jänne PA, Shitara K, Siena S, Cortés J. Trastuzumab deruxtecan in HER2-positive metastatic breast cancer and beyond. Expert Opin Biol Ther 2021; 21:811-824. [PMID: 33759669 DOI: 10.1080/14712598.2021.1890710] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Despite the substantial improvements made in human epidermal growth factor receptor 2 (HER2)-targeted therapies since the approval of trastuzumab more than 20 years ago, there is still considerable unmet need in patients with HER2-expressing breast cancer (BC) and other solid tumors. Trastuzumab deruxtecan (T-DXd) is a newer antibody-drug conjugate approved for the treatment of metastatic breast cancer (BC) and gastric cancer (GC) and is under active investigation in other solid tumors, including non-small cell lung cancer, colorectal cancer, and HER2-low tumors. AREAS COVERED The current treatment and investigational landscape of HER2-positive and HER2-low metastatic BC (mBC) and the preclinical and clinical trials investigating T-DXd. To identify relevant literature, a search was performed on English-language publications and congress abstracts. EXPERT OPINION T-DXd is likely to become the standard of care for second-line treatment of HER2-positive mBC, and it may play a role in the treatment of hormone receptor-positive and triple-negative mBC with HER2-low expression. Because it was recently approved in the United States and Japan to treat HER2-positive metastatic GC, it holds promise for the treatment of other HER2-positive solid tumors, including colorectal cancer, non-small cell lung cancer, and HER2-low BC.
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Affiliation(s)
- Jose Perez
- International Breast Cancer Center, Quiron Group, Barcelona, Spain.,Medical Department, Medica Scientia Innovation Research (MedSIR), Valencia, Spain
| | - Laia Garrigós
- International Breast Cancer Center, Quiron Group, Barcelona, Spain
| | - Maria Gion
- Quironsalud Group, Madrid, Spain.,Department of Medical Oncology, Hospital Universitario Ramón Y Cajal, Madrid, Spain
| | - Pasi A Jänne
- Department of Medical Oncology, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kohei Shitara
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Salvatore Siena
- Department of Oncology and Hematology-Oncology, Università Degli Studi Di Milano, Milan, Italy.,Niguarda Cancer Center Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Javier Cortés
- International Breast Cancer Center, Quiron Group, Barcelona, Spain.,Medical Department, Medica Scientia Innovation Research (MedSIR), Valencia, Spain.,Department of Medical Oncology, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Abstract
Trastuzumab deruxtecan (ENHERTU®), a HER2-directed antibody and DNA topoisomerase I inhibitor conjugate, is being developed for the treatment of HER2-expressing solid tumours, including breast cancer, gastric cancer, colorectal cancer and non-small cell lung cancer by Daiichi Sankyo Company Ltd in collaboration with AstraZeneca. Based primarily on the results of the phase 2 DESTINY-Breast01 trial, trastuzumab deruxtecan was recently approved in the USA under accelerated approval for the treatment of adult patients with unresectable or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting. This article summarizes the milestones in the development of trastuzumab deruxtecan leading to this first approval.
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Affiliation(s)
- Susan J Keam
- Springer Nature, Mairangi Bay, Private Bag 65901, Auckland, 0754, New Zealand.
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Yin O, Xiong Y, Endo S, Yoshihara K, Garimella T, AbuTarif M, Wada R, LaCreta F. Population Pharmacokinetics of Trastuzumab Deruxtecan in Patients With HER2-Positive Breast Cancer and Other Solid Tumors. Clin Pharmacol Ther 2020; 109:1314-1325. [PMID: 33118153 PMCID: PMC8246728 DOI: 10.1002/cpt.2096] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/17/2020] [Indexed: 12/26/2022]
Abstract
Trastuzumab deruxtecan (DS‐8201) is a human epidermal growth factor receptor 2 (HER2)–targeting antibody–drug conjugate with a novel enzyme‐cleavable linker, a topoisomerase I inhibitor payload, and a drug‐to‐antibody ratio of ≈ 8. We have characterized the population pharmacokinetics (PK) of trastuzumab deruxtecan and released drug (topoisomerase I inhibitor) in patients with HER2‐positive breast cancer or other solid tumor malignancies. This analysis includes pooled data from five clinical studies with 639 patients. Trastuzumab deruxtecan doses ranged from 0.8 to 8.0 mg/kg every 3 weeks. Serum concentrations of trastuzumab deruxtecan and released drug were analyzed using a sequential two‐step approach, with the nonlinear mixed‐effects modeling methods. Covariate assessment was based upon stepwise forward‐addition and backward‐elimination process, followed by both univariate and multivariate analysis quantifying their impact on steady‐state exposure of trastuzumab deruxtecan and released drug. A two‐compartment model with linear elimination best described PK profiles of intact trastuzumab deruxtecan, while a one‐compartment model with time‐varying release‐rate constant and linear elimination described released‐drug PK profiles. Statistically significant covariates (country, tumor size, sex, formulation, age, body weight, albumin, total bilirubin, and aspartate aminotransferase) resulted in < 20% change in steady‐state area under the concentration‐time curve of trastuzumab deruxtecan and released drug, except for increased body weight (95th percentile, 86 kg) and decreased albumin (5th percentile, 31 g/L). Analysis of patients stratified by country, race, renal function, and hepatic function found no clinically meaningful differences in steady‐state exposure of intact trastuzumab deruxtecan or released drug. Overall, results suggest that no dose adjustment based on tested covariates or in specific patient populations is warranted.
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Affiliation(s)
- Ophelia Yin
- Quantitative Clinical Pharmacology and Translational Sciences, Daiichi Sankyo, Inc, Basking Ridge, New Jersey, USA
| | - Yuan Xiong
- Certara Strategic Consulting, Princeton, New Jersey, USA
| | - Seiko Endo
- Clinical Pharmacology Department, Daiichi Sankyo Co, Ltd, Tokyo, Japan
| | | | - Tushar Garimella
- Quantitative Clinical Pharmacology and Translational Sciences, Daiichi Sankyo, Inc, Basking Ridge, New Jersey, USA
| | - Malaz AbuTarif
- Quantitative Clinical Pharmacology and Translational Sciences, Daiichi Sankyo, Inc, Basking Ridge, New Jersey, USA
| | - Russ Wada
- Certara Strategic Consulting, Princeton, New Jersey, USA
| | - Frank LaCreta
- Quantitative Clinical Pharmacology and Translational Sciences, Daiichi Sankyo, Inc, Basking Ridge, New Jersey, USA
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Bartsch R. Trastuzumab-deruxtecan: an investigational agent for the treatment of HER2-positive breast cancer. Expert Opin Investig Drugs 2020; 29:901-910. [PMID: 32701032 DOI: 10.1080/13543784.2020.1792443] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The prognosis of patients with HER2-positive breast cancer was dramatically changed by the introduction of targeted therapies. With trastuzumab, pertuzumab, and T-DM1 widely used as (neo)adjuvant therapy today, novel treatment options are required to optimize treatment of HER2-positive metastatic disease. Trastuzumab-deruxtecan is an antibody-drug conjugate (ADC) consisting of a monoclonal humanized immunoglobulin G1 antibody, a linker molecule, and the exatecan derivative DXd. T-DXd has a higher drug to antibody ratio compared with T-DM1; in addition, membrane permeability of DXd is high, resulting in an increased bystander effect. Results from early clinical development suggest a clinically relevant activity of T-DXd in heavily pretreated patients with HER2-positive metastatic breast cancer progressing on T-DM1. Interstitial lung disease was a side-effect requiring special attention and was observed in approximately 13% of patients. AREAS COVERED This article reviews preclinical and clinical data on T-DXd. A systematic literature search was performed to identify relevant publications. The search included original research articles, abstracts from major conferences, and reviews and was limited to English-language publications. EXPERT OPINION T-DXd is an efficacious and tolerable drug and harbors promise as a key addition to the therapeutic field in HER2-positive breast cancer.
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Affiliation(s)
- Rupert Bartsch
- Department of Medicine I, Division of Oncology, Medical University of Vienna , Vienna, Austria.,Comprehensive Cancer Center Vienna , Wien, Austria
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