Dr. Shanu Modi: How to Get a Standing Ovation at ASCO?
Episode Notes
The short answer to our title question is that you present a clinical trial that’s a game-changer for treating metastatic breast cancer. That’s what happened in June when Shanu Modi, MD, medical oncologist and attending physician at Memorial Sloan Kettering Cancer Center, shared the results of the DESTINY-Breast04 trial at the American Society of Clinical Oncology meeting.
DESTINY Breast04 showed that trastuzumab deruxtecan aka Enhertu aka TDXd, a drug that combines an antibody with a chemotherapy, can extend survival in HER2-low MBC patients. It is the first HER2 targeted therapy to demonstrate statistically significant and clinically meaningful improvements in progression-free survival and overall survival compared to standard chemotherapy for patients with HER2-low metastatic breast cancer. Further, its benefits were seen across breast cancer subgroups including both hormone receptor positive and negative patients.
In this episode, we continue the exploration of HER2-low and Enhertu we began in Episode 2 of our season 5 series. Our MBC Life’s Victoria Goldberg and Lynda Wetherby both saw the history-making presentation at ASCO and were thrilled to have the chance to follow up with Dr. Modi, who was lead researcher on the DESTINY trial. The following are some of the questions and issues covered in their lively conversation.
What makes Enhertu (Trastuzumab deruxtecan) different from other chemotherapy? What does it mean that it is an “antibody drug conjugate”
Who can benefit from the drug? What does that look like for TNBC as well as ER+ patients?
What “adverse events” or side effects were seen in the trial? How can they be minimized and managed?
What comes next—what do the results of the DESTINY Breast 04 trial mean for current and future research?
If you have not done so already, listen to our October 12 Episode, MBC101: the HER2-low Show, for a deep dive on how pathologists are dealing with the new challenge of HER2-low—and what you can do to make sure you know your HER2 status.
Glossary
Novel Therapies Mentioned in the Episode
Clinical Trials Mentioned in this Episode
Phase 1b/2 BEGONIA study of durvalumab combinations in locally advanced/metastatic triple-negative breast cancer (TNBC) ( NCT03742102)
Phase 3 DESTINY-Breast03 study (NCT03529110)
Phase 3 DESTINY-Breast04 Trastuzumab Deruxtecan (DS-8201a) Versus Investigator's Choice for HER2-low MBC (NCT03734029)
Phase 3 DESTINY-Breast06 Trastuzumab Deruxtecan (T-DXd) vs Investigator's Choice Chemotherapy in HER2-low, Hormone Receptor Positive, Metastatic Breast Cancer (NCT04494425)
Platform Phase 1b/2 DESTINY-Breast07 Study of T-DXd Combinations in HER2-positive Metastatic Breast Cancer (includes active brain mets arm) (NCT04538742)
Platform Phase 1b/2 DESTINY-Breast08 Study of T-DXd Combinations in HER2-low Metastatic Breast Cancer (includes immunotherapies) (NCT04556773)
Phase 3 DESTINY-Breast12 Study of T-DXd in Participants With or Without Brain Metastasis Who Have Previously Treated Advanced or Metastatic HER2 Positive Breast Cancer (NCT04739761)
Phase 2 DAISY Study of T-DXd for Advanced Breast Cancer Patients, With Biomarkers Analysis (NCT04132960
Phase 3 TULIP Study o trastuzumab duocarmazine vs. Physician's Choice in Participants With HER2-positive Locally Advanced or Metastatic Breast Cancer (NCT03262935)
Want more?
Check out Last Week’s MBC101 Episode
Meet the Guest of this Episode
Growing up in a small farming community in rural Missouri, Stephanie Lynn Graff, MD, FACP was the first in her family to attend college. Because she was drawn to science from a young age, she enrolled in a 6-year medical program right out of high school. As she progressed from medical school to residency to a fellowship, she was fascinated by every aspect of the science of oncology—including cell biology and pharmacology.
Dr. Stephanie Graff is the Director of Breast Oncology at Lifespan Cancer Institute at the Legorreta Cancer Center at Brown University in Providence, Rhode Island. Dr. Graff serves as co-lead of the Breast Cancer Translational Research Disease Working Group at Brown University and is an Assistant Professor of Medicine at the Warren-Alpert School of Medicine. Prior to joining the team at Lifespan/Brown, she was Director of both the Breast Program and Clinical Research at the Sarah Cannon Cancer Institute at HCA Midwest, as well as Associate Director of the Breast Cancer Research Program at Sarah Cannon Research Institute and National Breast Lead for the Sarah Cannon Cancer Network’s clinical programs. In addition, Dr. Graff serves as a medical advisor to the Dr. Susan Love Foundation for Breast Cancer Research.
Dr. Graff is board certified in Medical Oncology, Hematology, and Internal Medicine; and completed a breast oncology sub-fellowship at the University of Kansas. Dr. Graff has broad experience as a Principal Investigator on numerous clinical trials across all phases of drug development, in addition to work in translational research, genomics, and gender bias. In addition to scientific publications, she is an award-winning writer, social media influencer, and sought-after public speaker. Dr. Graff has received the Frist Humanitarian Award for her work in the community and the Benjamin L. Sapers Memorial Award for her “passion for pedagogy, academic rigor, empathy and humanism, with profound feeling for the person as patient.” Dr. Graff currently serves on the American Cancer Society Rhode Island Leadership Council and actively volunteers in the American Society of Clinical Oncology, where she is a 2020 graduate of the prestigious ASCO Leadership Development Program, and now serves on the Joint Certifications Committee and Women In Oncology Work Group. Ultimately, Dr. Graff is passionate about connecting with her patients to provide personalized, comprehensive oncology care, advancing breast cancer research, and breast cancer prevention.