Loading
Nearly half of women with metastatic triple-negative breast cancer develop brain metastases and survive under five months after the diagnosis, yet the trials that set the standard mostly exclude active brain disease. Requiring a brain metastasis cohort in every phase 3, with intracranial response as an endpoint, would answer whether the new drugs reach the brain.
Lin's Dana-Farber series found central nervous system metastases in 14 percent at first metastatic diagnosis and 46 percent before death, with a median survival of 4.9 months after the brain diagnosis and only 3 of 53 patients with controlled systemic disease, arguing that the problem is a lack of effective therapy rather than a sanctuary effect. The immunotherapy and antibody-drug conjugate trials generally admitted only treated, stable brain metastases and did not report intracranial endpoints; trastuzumab deruxtecan has shown intracranial activity in HER2-positive disease, and case series suggest sacituzumab govitecan crosses into brain lesions, but there is no randomised evidence in triple-negative disease. The bottleneck record for brain delivery describes the general problem.
The first-line overall survival result that made an antibody-drug conjugate the standard for PD-L1-negative or immunotherapy-ineligible metastatic triple-negative disease, and the reason the sequencing question (which TROP2 drug first, what after it) is now urgent.
The 13.3-month median is the pre-immunotherapy, pre-antibody-drug conjugate benchmark against which first-line trials now reporting medians near two years are measured; the brain metastasis rate is why trials that exclude active brain disease leave the question unanswered.
Shares Datopotamab deruxtecan in patients with untreated, advanced triple-negative breast cancer (TROPION-Breast02): a randomised, open-label, international, phase III trial, Datopotamab deruxtecan, Sacituzumab govitecan, Trastuzumab deruxtecan and the tag tnbc-evidence.
Shares Datopotamab deruxtecan, Sacituzumab govitecan, Trial design, endpoints and cost, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem and the tag tnbc-evidence.
Shares ASCENT-04 / KEYNOTE-D19, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Triple-negative breast cancer (TNBC) and the tag tnbc-evidence.
Shares Trastuzumab deruxtecan, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Antibody-drug conjugate (ADC), Triple-negative breast cancer (TNBC) and the tag tnbc-evidence.
Shares Trial design, endpoints and cost, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Triple-negative breast cancer (TNBC) and the tag tnbc-evidence.
Shares Trastuzumab deruxtecan, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Triple-negative breast cancer (TNBC) and the tag tnbc-evidence.
Shares Trial design, endpoints and cost, Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Triple-negative breast cancer (TNBC) and the tag tnbc-evidence.
Shares Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem, Triple-negative breast cancer (TNBC) and the tag tnbc-evidence.