DESTINY-Breast03 trial: some questions remain - Authors' reply.

Lancet

International Breast Cancer Center, Pangaea Oncology, Quironsalud Group, Barcelona, Spain; Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain.

Published: May 2023

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http://dx.doi.org/10.1016/S0140-6736(23)00681-5DOI Listing

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Quality-adjusted time without symptoms or toxicity analysis of trastuzumab deruxtecan versus trastuzumab emtansine in HER2- positive metastatic breast cancer patients based on secondary use of the DESTINY-Breast03 trial.

Eur J Cancer

December 2024

International Breast Cancer Center, Quirónsalud Group, Barcelona, Spain; IOB Madrid, Hospital Beata Maria Ana, Madrid, Spain; Medica Scientia Innovation Research (MEDSIR) - Oncoclínicas & Co, Jersey City (New Jersey, USA), Sao Paulo, Brazil; Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain.

Objective: DESTINY-Breast03, a randomised, phase 3 trial, evaluated trastuzumab deruxtecan (T-DXd) versus trastuzumab emtansine (T-DM1) in patients with human epidermal growth factor receptor (HER2)-positive unresectable and/or metastatic breast cancer who progressed on or after treatment with trastuzumab and a taxane. At the current data cut off overall survival analysis, T-DXd demonstrated a substantial improvement in overall survival over T-DM1. This secondary analysis use of DESTINY-Breast03 aimed to further evaluate the treatment differences using quality-adjusted survival time without symptoms or toxicity (Q-TWiST) methods.

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Background: Breast cancer (BC) is one of the most common cancers worldwide. The inevitability of drug resistance to initial anti-HER-2 therapy necessitates the emergence of second-line anti-HER-2 drugs which exhibit a promising outlook. Consequently, it is imperative to appraise their efficacy through network meta-analysis and ascertain their comparative cost-effectiveness.

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The global phase 3 DESTINY-Breast03 study (ClinicalTrials.gov; NCT03529110) showed statistically significant and clinically meaningful improvements in progression-free survival (PFS) and overall survival (OS) with trastuzumab deruxtecan (T-DXd) over trastuzumab emtansine (T-DM1) in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (mBC) previously treated with trastuzumab and a taxane. Here, we report a subgroup analysis of Asian patients enrolled in DESTINY-Breast03.

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Article Synopsis
  • Trastuzumab deruxtecan (T-DXd) showed significantly better effectiveness compared to trastuzumab emtansine (T-DM1) for patients with advanced HER2-positive metastatic breast cancer in the DESTINY-Breast03 study, with a follow-up of 41 months.
  • The results revealed a median progression-free survival (PFS) of 29.0 months for T-DXd versus 7.2 months for T-DM1, along with improved overall survival (OS) of 52.6 months compared to 42.7 months.
  • Safety profiles were consistent with earlier data, and no new severe cases of interstitial lung disease or pneumonitis were observed, indicating that
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