Highlights

So, as far as unmet needs are concerned, we still need drugs that are better tolerated without severe cardiac side effects, from a TNBC standpoint we need better chemotherapy and targeted agents, and especially in the metastatic disease setting we need drugs that can cure the disease. In HR+ disease, in the adjuvant setting we still need drugs that have less side effects than aromatase inhibitors and tamoxifen, and help patients complete at least five years of endocrine therapy much better in order to improve compliance. As far as advanced stage disease is concerned, we still don’t consider anybody with HR+/HER2- advanced stage disease as cured, so we still need drugs that can cure advanced stage disease, although there are some HER2+ breast cancer patients who are, but that’s not the case with TNBC and HR+/HER2- at this point.

At this point, I think DESTINY-Breast04 is a fantastic study in terms of practice change. It is a drug that is definitely giving more options to patients because these patients have heavily relapsed disease, and they progress on multiple lines of therapy. Beyond endocrine therapy, unfortunately these patients don’t have great options other than chemotherapeutic agents, which are of course limited by their adverse event profile. So, that’s the reason why I think this is a great drug, we’ve already seen how active it is in the greater part of breast cancer patients, but because of its chemotherapy-to-antibody ratio – the high chemotherapy-to-antibody ratio is 8:1, and the fact that it has this bystander effect, I think it is able to act on even the HER2 1+ and 2+ FISH non-amplified patients.