ADC Use Rapidly Growing in Metastatic Breast Cancer Treatment

Use of antibody-drug conjugates (ADCs) rapidly on the rise among patients with breast cancer, but age-based disparities persist with older women receiving the treatment far less often than younger patients, new data have shown.

ADC treatment rates increased 3.7-fold from 2021 to 2023, with an increase from 1,353 to 4,965 per 100,000 newly diagnosed patients with metastatic breast cancer, while the median time to treatment was slashed from nearly a year — 331 days — to 109 days. This is according to a data analysis from Komodo Health, which works in AI-powered healthcare intelligence, conducted in collaboration with the Tigerlily Foundation, an advocacy organization for patients with breast cancer.

But that rapid uptake in treatment was not experienced equally. Women who were 66 years old and older had the lowest ADC treatment rates, receiving treatment after a median of 242 days at a rate 3.4 time slower than the treatment rate for 19-to-35-year-olds.

Via its Healthcare Map tracking the healthcare journey of more than 330 million de-identified United States-based patients, Komodo reportedly analyzed treatment patterns among approximately 17,000 women who were newly diagnosed with metastatic breast cancer and were treated with one of three ADCs that have been approved by the U.S. Food and Drug Administration (FDA): Kadcyla, Enhertu and Trodelvy, according to a news release issued by the company.

Further findings showed that Black women had the highest overall treatment rate with ADCs, driven by Trodelvy for triple-negative breast cancer, while Asian women had higher rates of HER2-targeted ADCs Enhertu and Kacdyla and White women had lower overall ADC usage. Additionally, Medicaid claims showed patients with the highest treatment rates, which were almost double the rate of Medicare patients and higher than patients who were covered by commercial insurance.

“The encouraging patterns we see in this analysis — where ADC utilization aligns with disease biology — suggest that equitable outcomes are possible in precision medicine. Understanding the factors that contributed to these patterns can inform future therapeutic development," said Maimah Karmo, CEO and Founder, Tigerlily Foundation, in the news release "However, the question of why older women have significantly lower treatment rates remains critical and demands investigation to ensure appropriate care for all patients."

These findings were delivered with Komodo’s AI platform, Marmot, which is used to quickly analyze complex care patterns.

"Our analysis uncovers a dual reality of precision oncology today: the progress in quickly adopting life-saving therapies like ADCs, coupled with systemic barriers that create disparate access for older patients," said Dr. Tabby Khan, Senior Director of Analytics at Komodo Health. "By leveraging the speed and precision of Marmot, we are able to not only track progress but also pinpoint these critical gaps to health equity, empowering the entire healthcare ecosystem with the evidentiary view and data needed to understand where policy and practice must be adapted to ensure every patient, regardless of age, benefits from innovative therapeutics."

How Do ADCs Work to Treat Cancer?

Dr. Yuan Yuan — a professor of medicine, director of Breast Oncology and medical director of Breast Cancer Research at Cedars-Sinai Medical Center in Los Angeles, as well as a health sciences clinical professor at UCLA — spoke with CURE last year about how ADCs work to treat breast cancer.

“I usually describe antibody-drug conjugates as a new class of designer drug, where the target-specific antibody was attached to a small amount of chemotherapy [payload], in contrast to conventional chemotherapy with a larger amount of drug to enter the body,” said Yuan. “Here, the idea is to do a cancer cell-specific delivery.”

Antibody-drug conjugates, Yuan explained, usually have a “head” made up of an antibody targeted to a receptor such as the protein human epidermal growth factor receptor 2 (HER2) found on cancer cells, and that antibody is linked to a cytotoxic payload, such as a chemotherapy drug, that remains relatively stable outside of the targeted cell. Once it arrives at its delivery destination and enters the tumor cell, the linker breaks off and the drug is released.

References

1. “Komodo Health Analysis Uncovers Dual Reality in Metastatic Breast Cancer Care: Rapid Targeted Cancer Therapy Adoption Amid Glaring Age-Related Disparities,” news release; https://www.businesswire.com/news/home/20251020693892/en/Komodo-Health-Analysis-Uncovers-Dual-Reality-in-Metastatic-Breast-Cancer-Care-Rapid-Targeted-Cancer-Therapy-Adoption-Amid-Glaring-Age-Related-Disparities
2. “Finding Hope With Antibody-Drug Conjugates in Managing Breast Cancer,” CURE; https://www.curetoday.com/view/finding-hope-with-antibody-drug-conjugates-in-managing-breast-cancer

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