Closing Thoughts on Evolving Antibody-Drug Conjugate Landscape

A panel of 6 experts on breast, lung, and gastrointestinal cancers

The expert panel concludes the program with key takeaways and closing thoughts on the evolving antibody-drug conjugate space.

Sponsored in part by Daiichi Sankyo. Content independently developed by OncLive®.


Benjamin P. Levy, MD: I just want to go around the room, just parting shots in 10 seconds or less, for regimens based on whatever it may be, either the targeted therapy paradigm, testing in your own discipline, maybe leveraging the ADC [antibody-drug conjugate] story as well. It's always a pleasure for me to pick on Ben [Dr Musher] first. Ben, can start us out with just your parting shots?

Benjamin L. Musher, MD: Sequencing for everybody. I think we need to get away from this sort of targeted testing of things so we can get a view of everything for clinical as well as research purposes. We didn't talk about colorectal cancer, but this conversation is also relevant in colorectal cancer with 5% of HER2 overexpression. And we also see mutations sometimes. So, that's a totally different conversation but there is much more to come in this field because I think it's still pretty wide open.

Benjamin P. Levy, MD: Great. Michal, your final parting shots, here?

Michal F. Segal, RN: I agree. I think this is an interesting area and I thought of something I want to say before in terms of getting testing done. You want to encourage patients to reach out. I know somebody mentioned Tempus; there are a few outside labs, so any kind of proactive testing patients can do, either liquid or biomarker testing, they should go for it.

Benjamin P. Levy, MD: Kayla, [do you have] any parting shots?

Kayla Freeman, DNP, APRN, FNP-C: I just wanted to thank you, it's been a pleasure being on this panel. It's been very informative to hear about all the ADCs that are being used across disease groups. It's very exciting for patients to see what's to come. And again, as you [all] mentioned, sequencing, I think it’s going to get harder as things get approved because [we have to consider] what do we use them with and when do we use them based on how it's working for the patient?

Benjamin P. Levy, MD: Great. Rasheda?

Rasheda Persinger, MSN, AGNP-C, AOCNP: I think I will piggyback on what you stated in the beginning. I live for the day when testing in lung cancer mimics that of breast cancer, that it is unethical to start treatment with breast cancer without having HER2, ER [estrogen receptor], or PR [progesterone receptor][testing]. I live for the day that we do that complete NGS [next-generation sequencing] testing on lung cancer, especially in the advanced metastatic state for treatment.

Benjamin P. Levy, MD: Kevin [Dr Kalinsky], I'll give you the last word.

Kevin Kalinsky, MD, MS: The one additional thing that I'll say is trastuzumab deruxtecan was just given potential breakthrough designation for patients who have HER2-low disease. I think we'll see if we have approval for a drug across different disease types based upon having HER2 expression that would be unique with ADCs. We do have this, of course, for pembrolizumab in patients who have, for instance, MSI [microsatellite instability]-high [disease]. But we'll see whether that is the case with ADCs.

Michal F. Segal, RN: I just want to add one thing. We talked earlier about talking to patients about waiting. And I did want to mention that waiting 2 or 3 weeks as explained to patients, that the biomarker testing is so extremely important, [as] it's going to guide 20% to 30% of patients who are HER2 positive. And sometimes we will start with a treatment regimen and say HER2 is probably negative. But if we get back that it's [actually] positive, it changes everything. And just anecdotally, the other day we were going to start a patient with a regimen that we assumed would be best, and then we got the pathology back and he was MSI high. So, just waiting for those things, we know it could be stressful to wait 2 or 3 weeks, but they completely dictate therapy, so it's worth it.

Benjamin P. Levy, MD: Great point. I'll just finish with 2 points. No. 1, I think we're only at the beta version of these ADCs. I think we're just beginning to scratch the surface. I mean, bispecific ADCs, where again, the monoclonal antibody binds to 2 different epitopes, dual payload ADCs. We have 2 different payloads, ADCs with these immune-stimulating payloads, radio and nucleotide ADCs. I think we will figure out how to use these better. I think we're in the early TKI [tyrosine kinase inhibitors] stage, when we are dealing with these very dirty tyrosine kinase inhibitors that aren’t very selective. We've come so far in lung cancer, developing these very selective compounds, and I think that's what will happen with ADCs. So I look forward to seeing what happens.

And then, No. 2 as Rasheda [Persinger] knows, I always say, I've said a few times here today, it takes a village. None of us alone can do this now with our patients. We need our APPs [advance practice providers], we need our nursing, we need our social workers, and we need our pain and palliative care folks. We need our advocacy. It's become very complex, and we can't do it alone. I hope I didn't leave anyone out, but I probably did. But it really takes a lot of folks to get patients through their journey, and it's an honor to do that. It's also been an honor for me to moderate this, and I've learned a lot. I really want to thank you all and our viewing audience. We hope you found this OncLive Peer Exchange discussion to be useful and informative.

Transcript is AI-generated and edited for clarity and readability.

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