Nancy Davidson, MD, from Seattle Cancer Care Alliance and Fred Hutchinson Research Center, discussed advancements in breast cancer and what to look forward to in the space.
I have the great opportunity of serving as the discussant or the presenter of the highlights of the day for the abstracts about early breast cancer management. So that session is going to cover a diversity of topics; abstracts that have to do with how we give anti-HER2 therapy to early breast cancer patients, abstracts that have to do with how we give hormone therapy, especially extended hormone therapy, and then some abstracts that have to do with the surgical management or the management of early stage breast cancer as well as triple negative breast cancer. In my particular discussion, I’m going to focus largely on the abstracts that have to do with hormone therapy and that have to do with anti-HER2 therapy.
Now in the anti-HER2 world, you know, we have a lot of active agents now that we can use in early breast cancer. And one of the things we’re struggling with is how to use them the most effectively. And we’re also facing the happy situation that we wonder whether we might actually be overtreating some of those patients. And so, we’re beginning to think about whether we can optimize, tailor, our therapy a little bit more effectively so that we can maximize the anti-breast cancer qualities, but we can also minimize the side effects. So there are a couple of abstracts that are going to talk about that, the drug called ado-emtansine or T-DM1, a form of anti-HER2 therapy that’s clipped to a chemotherapy, and whether or not we can use that more effectively in earlier stages of breast cancer. Just now it’s an agent that’s used for late breast cancer. It also was just approved by the FDA just a few weeks ago to use in a situation where patients have residual breast cancer after they’ve gotten preoperative therapy in surgery. So exciting time to think about how to optimize that kind of therapy.
The second area that we’ll talk about in great detail is the question of what we call extended adjuvant endocrine therapy. You know anybody who has positive receptor breast cancer, invasive breast cancer, is going to get adjuvant endocrine therapy with either tamoxifen (Soltamox) or an aromatase inhibitor or sometimes a sequence of those, and we routinely give it for 5 years. And there’s a lot of interest in whether or not we should give it for longer periods of time. But we have the same struggle that right now we have to treat a lot of patients to benefit a small subset of them. And so, we’re trying to figure out who should get the therapy and who shouldn’t. So that session has some work looking at biomarkers that we might be able to use to try to help to shade who are the high-risk individuals. That’s one big part of the session.
The last part is that this meeting a year ago, we heard the presentation of something called the TAILORx trial. Huge National Cancer Institute sponsored trial that looked at the role of a multi-gene test to try to help to figure out who needs chemotherapy in addition to hormone therapy for early stage node-negative breast cancer, and who does not. And that trial showed that women whose tumors had a recurrence score in the lower intermediate range really didn’t benefit from chemotherapy at all. So, it allowed us to really reserve chemotherapy for those whose tumors showed the highest recurrence score. At this particular meeting, we’re going to hear the results of a study that tried to look at that genomic information, that molecular information, in context with information about the clinical status of the tumor, how big is the tumor, what’s the grade of the tumor. So, looking at the clinical grade and the genomic grade and trying to figure out if you integrate those clinical and biological factors, whether you’d be even more effective at selecting who should get what. And I think this study will show that you can use those things to your benefit, and especially for our younger women, for some of our premenopausal women, it looks like the clinical information and the molecular information together is going to be the most powerful to help us decide what kind of therapy those women should get in addition to the normal therapy. So exciting time because it was a huge study next year, and now we’re seeing the refinements this year as we try to take it ever farther into practice.