Evolving Treatment Sequencing, Targeted Therapies Shape a New Era of Breast Cancer Care: Kathrin Dvir, MD, MSc

In part 1 of an interview with The American Journal of Managed Care^®, Kathrin Dvir, MD, MSc, assistant professor of medicine and oncology at Moffitt Cancer Center, discussed how the shift toward personalized, biomarker-driven breast cancer care is increasingly shaping managed care treatment decisions and coverage policies. She also explained how treatment sequencing in both the neoadjuvant and adjuvant settings has evolved as newer therapies, such as antibody-drug conjugates (ADCs), move into earlier lines of treatment.

Although many patients across the breast cancer continuum still receive a more generalized treatment approach, Dvir emphasized that care in the metastatic setting has become far more individualized. Treatment is now often guided by specific genetic alterations, particularly in hormone receptor–positive and HER2-negative disease, with similar advances emerging in HER2-positive and triple-negative subtypes.

She highlighted that targeted therapies for mutations such as PIK3CA and ESR1 have improved clinical outcomes and helped delay the need for chemotherapy, allowing patients to preserve their quality of life. Additionally, in HER2-positive disease, ADCs such as trastuzumab deruxtecan (T-DXd; Enhertu; Daiichi Sankyo, Inc.) have demonstrated substantial efficacy across metastatic, neoadjuvant, and adjuvant settings, especially among high-risk patients.

Despite these benefits, Dvir underscored that safety and tolerability remain significant concerns. While highly effective, she explained that T-DXd carries risks of serious and even fatal adverse events, most notably interstitial lung disease (ILD). In addition, she acknowledged the limited guidance on monitoring ILD in early-stage disease, as insurance coverage for necessary imaging can be inconsistent.

Dvir explored these issues with fellow experts during last month’s Institute for Value-Based Medicine^® event, “Pioneering The Next Era of Oncology Care,” held in Tampa, Florida. She joined Jeanine Ewing, PharmD, BCOP, of Florida Cancer Specialists & Research Institute for the panel discussion “Targeted Success: Operationalizing Therapies in Breast Cancer,” moderated by Hatem Soliman, MD, of Moffitt Cancer Center.