The use of antibody drug conjugates in breast cancer – a short report based on specialists’ opinion

Introduction. This review begins by presenting the evolution in the discovery of antibody-drug conjugates (ADC) compounds and their clinical use. In the main part, there are presented the recent trials which determined the actual indication of ADC in advanced breast cancer. Revised material. The following papers were revised: Judy King, Giuseppe Curigliano, Peter Schmid. Antibody-Drug Conjugates in Practice. Contemporary Questions for the Treatment of Metastatic Breast Cancer; Relecom A, Sciotto F, Chevallier M, Sandoval JL. Antibody-Drug Conjugates in the Treatment of Metastatic Breast Cancer: The Emerging Questions of Sequence and Resistance; Paolo Tarantino, Valentina Guarneri, Rebecca A Dent. Hot Topics from Berlin 2025: What Experts Say About the Future of Metastatic Breast Cancer (available on Medscape). We set out to create a “state of the art” in the use of anti-HER2 compounds by reproducing a podcast by specialists in the field of antibody-drug conjugates in practice. We also tried to determine, based on the examined materials, what role chemotherapy still has in the therapy of HER2-positive breast cancer. Conclusions. The analysis of the studies that defined the use of ADC in breast cancer, carried out by the authors cited above, reveal the complexity of choosing the ADC treatment in HER2-positive, low and ultralow breast cancer. This complexity should determine a looser indication in the insurance companies’ guidelines to give the doctor the opportunity to better appreciate all the parameters that must be taken into account in the indication for this therapy. Another issue is that some specialists claim that there is still a problem in identifying HER2 low and HER2 ultralow. We also present the role of first-, second-, and third-generation HER2 inhibitors in the therapy of advanced breast cancer, ER positive, HER2 low and ultralow. In this regard, we reproduce some relevant aspects of the NCCN guidelines. Last but not least, we emphasize the sequence of CDK4/6 inhibitors and HER2 inhibitors. The review ends with an NCCN table presenting the main actual ADC indications in advanced breast cancer, according to HER2 status.