ADCs in CNS Disease and Managing Patients With Multiple Biomarkers

The panel addresses one of the more difficult challenges in metastatic TNBC: central nervous system involvement. Panelists review the elevated risk of brain metastases in this population, their associated prognosis, and the historical exclusion of these patients from clinical trials, a longstanding evidence gap. The discussion explores questions around whether large ADC molecules can cross the blood-brain barrier and act within the CNS, and how accumulating data have prompted growing interest in studying these agents in patients historically excluded from trials. The segment closes with a practical exchange on patients who cross multiple biomarker subgroups, for example, those who are both PD-L1 positive and germline BRCA altered, exploring how to prioritize among checkpoint inhibition, PARP inhibitors, platinum-based therapy, and ADCs while keeping later-line options open. Panelists also discuss re-challenging with prior therapies and the role of repeat tumor sequencing. Viewers gain insight into individualizing therapy in complex clinical scenarios.