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We compared the association between peripheral blood biomarkers and outcomes in patients with breast cancer treated with T-DM1 and T-DXd.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Eighty-five women treated with T-DM1 (<jats:italic>n<\/jats:italic>\u2009=\u200940) or T-DXd (<jats:italic>n<\/jats:italic>\u2009=\u200945) for advanced disease were evaluated. Overall survival (OS) and OS after the end of treatment (EOT) were compared based on changes in absolute lymphocyte count (ALC) and neutrophil-to-lymphocyte ratio (NLR) between baseline and EOT.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In the T-DM1 group, patients with a low NLR at EOT had significantly longer OS after EOT than those with a high NLR (<jats:italic>p<\/jats:italic>\u2009=\u20090.007), and patients with a high ALC at EOT had longer OS after EOT (<jats:italic>p<\/jats:italic>\u2009=\u20090.071). In the T-DXd group, the ALC and NLR were not associated with OS. The exploratory subgroup analysis suggested that patients with high ALC at EOT had better OS after EOT (<jats:italic>p<\/jats:italic>\u2009=\u20090.038) in the T-DXd (HER2-low) group (<jats:italic>n<\/jats:italic>\u2009=\u200919), whereas ALC and NLR were not associated with the outcome in the T-DXd (HER2-positive) group (<jats:italic>n<\/jats:italic>\u2009=\u200926). Multivariable analysis revealed that the NLR at EOT was an independent prognostic factor for OS after EOT, after adjusting for clinicopathological factors, in the T-DM1 group (<jats:italic>p<\/jats:italic>\u2009=\u20090.019).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Immune status may influence treatment outcomes in the T-DM1 and T-DXd (HER2-low) groups. Conversely, in the T-DXd (HER2-positive) group, the treatment outcome was independent of immune status.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s10147-025-02768-4","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T02:47:14Z","timestamp":1745894834000},"page":"1331-1340","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical implications of peripheral blood biomarkers in patients with advanced breast cancer treated with trastuzumab emtansine and trastuzumab deruxtecan"],"prefix":"10.1007","volume":"30","author":[{"given":"Yusa","family":"Togashi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9308-448X","authenticated-orcid":false,"given":"Masayuki","family":"Nagahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aoi","family":"Oshiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gen","family":"Sugimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayumu","family":"Mitsuyoshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruka","family":"Kanaoka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Hattori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junko","family":"Tsuchida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Higuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arisa","family":"Nishimukai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuo","family":"Miyoshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"key":"2768_CR1","doi-asserted-by":"publisher","first-page":"2415","DOI":"10.1016\/S0140-6736(16)32417-5","volume":"389","author":"S Loibl","year":"2017","unstructured":"Loibl S, Gianni L (2017) HER2-positive breast cancer. 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Y Miyoshi has received research funding and honoraria from Eisai, Chugai, AstraZeneca, Eli Lilly, Pfizer, MSD, Kyowa-Kirin, Daiichi-Sankyo, and Taiho. Y Togashi, A Oshiro, G Sugimoto, A Mitsuyoshi, H Kanaoka, A Hattori, J Tsuchida, T Higuchi, A Nishimukai have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}