Giuseppe Curigliano
Breast oncologist and phase 1 leader who co-led DESTINY-Breast06 and shaped the HER2-low concept.
Giuseppe Curigliano runs early drug development at IEO and is a principal investigator in the DESTINY-Breast programme, including DESTINY-Breast06 in HER2-low and ultralow disease; he chairs ESMO guideline committees.
Patients with hormone-receptor-positive metastatic breast cancer that has stopped responding to endocrine therapy can be offered trastuzumab deruxtecan as their first chemotherapy-type treatment if the tumour shows any HER2 staining, rather than waiting until after conventional chemotherapy. Whether to use it before or after chemotherapy is now a choice, since overall survival was not shown to differ and the drug carries a risk of lung inflammation.
For HER2-positive metastatic breast cancer that has progressed after trastuzumab and a taxane, trastuzumab deruxtecan is now the standard second-line treatment and T-DM1 has moved later in the sequence. The benefit is large enough that ADC design, not just the target, is understood to be what matters. Patients need lung monitoring because of the risk of pneumonitis.