Ep. 52 Antibody Drug Conjugates Across the HER2 Spectrum: From HER2-Positive to Ultralow Breast Cancer with Dr. Sara Nunnery

Antibody-drug conjugates (ADCs) are expanding treatment options in breast cancer, but their use requires careful attention to toxicity. In this episode of the BackTable Tumor Board Podcast, Dr. Kate Baker and Dr. Sara Nunnery review the role of ADCs in HER2-positive disease and their growing application in HER2-low and HER2-ultralow metastatic settings. --- Get the BackTable app https://www.backtable.com/app --- Timestamps 00:00 - Introduction01:46 - How ADCs Work08:40 - ILD Risk and Monitoring13:46 - Next-Generation HER2 ADCs24:14 - HER2-Low and Ultralow Disease29:56 - Sequencing After Endocrine Therapy33:42 - Future Targets and Bispecifics38:08 - Wrap Up --- More about this episode The discussion outlines ADC mechanisms and recent trial-driven shifts in clinical practice, with emphasis on interstitial lung disease (ILD) risk, monitoring, and patient counseling. They address practical considerations including patient selection, sequencing after endocrine therapy, and potential maintenance approaches. Additional topics include evolving pathology reporting, considerations for earlier-stage use in high-risk patients, and the development of next-generation HER2- and HER3-targeted ADCs, as well as bispecific therapies. --- Resources DESTINY Breast 09https://www.nejm.org/doi/full/10.1056/NEJMoa2508668 DESTINY Breast 05https://www.nejm.org/doi/full/10.1056/NEJMoa2514661 DESTINY Breast 06https://www.nejm.org/doi/abs/10.1056/NEJMoa2407086