Breast Cancer Update HR-Positive and Triple-Negative Metastatic Breast Cancer — An Interview with Dr Laura Huppert on Optimal Integration of ADCs into Treatment
Oct 14, 2025
Dr. Laura Huppert, a medical oncologist at UCSF specializing in breast cancer, dives deep into the world of antibody-drug conjugates (ADCs). She explains how ADCs work and discusses their current use in treating HR-positive and triple-negative metastatic breast cancer. Listeners will find insights on managing ADC toxicities, the latest investigational therapies, and considerations for treatment sequencing. Huppert's enthusiasm for integrating innovations in ADCs hints at a promising future for breast cancer management.
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How ADCs Work And Limitations
- ADCs target cell-surface proteins to deliver chemotherapy directly into cancer cells and nearby tumor via a bystander effect.
- They remain chemotherapy and can cause systemic off-target toxicities like ILD and stomatitis.
Payloads Aren't Limited To Topo‑1
- Most approved breast ADCs use topoisomerase‑1 inhibitor payloads, though payload diversity is growing.
- Developers are pursuing non‑chemotherapy payloads and radioisotopes to expand mechanisms.
Prevent And Manage T‑DXd Toxicities
- Use a triplet IV antiemetic regimen and consider low‑dose olanzapine to prevent T-DXd nausea starting day one for seven days.
- Monitor for ILD with CT scans initially every nine weeks and treat grade 1 ILD with hold and steroid taper before rechallenge.