A Farewell to MBCC: Tripathy on His Years as Cochair

As the 41st Annual Miami Breast Cancer Conference approaches, Debu Tripathy, MD, prepares to step down as cochair.

It’s always been about the why for Debu Tripathy, MD. As a highly regarded leader in breast cancer treatment, that inquisitiveness made for an easy match to agree to cochair the Miami Breast Cancer Conference® (MBCC®), an event organized by Physician’s Education Resource.

“The meeting has always been about, ‘How am I going to treat the next patient I see?’ It is very clinically oriented, very practical, and very utilitarian,” Tripathy said in an interview with CancerNetwork®. “However, it’s utilitarian on a high level. I want to know the science behind it. I want to know why that’s the right thing to do. That’s what the magic is about [attending the] meeting. You understand that it’s not only because this is how we do it, but why it is, what the data behind it is, and how we might make it even better.

Tripathy, who is professor and chairman in the Department of Breast Medical Oncology, Division of Cancer Medicine, at The University of Texas MD Anderson Cancer Center in Houston, has served as cochair of the annual meeting for so many years, he’s lost count of the exact number. The 41st Annual MBCC, held March 7 to 10 at the Fontainebleau Miami Beach Miami Beach in Florida, will be Tripathy’s last as cochair.

In the interview, Tripathy reflected on his time as an MBCC cochair with some memorable moments, his plans for 2025 and beyond, and highlighted recent breast cancer treatment milestones that will be pivotal topics for this year’s discussions.

CancerNetwork: Think back to your very first time attending MBCC. What was that like? What made you want to get more involved with it as a cochair?

Tripathy: The first time I was invited to speak at MBCC, I didn’t know much about the history of the conference. By then I had been experienced and comfortable with giving lectures and picking my content. We were doing some interesting research; I was excited to present it. When I walked into that cavernous hall at the Loews Hotel [in Miami Beach, FL], I felt this energy that I had not seen before in a meeting. This is because the meeting has an aura about it, where not only the speakers, but the attendees just have this amazing attention focused on what you’re doing and what you’re saying; every word you’re saying matters.

It instantly hit me that everybody’s here to learn, they’re here to take it to a higher level, and they already know a lot. You better do a good job. That is the environment that I like. I thrive in it. I like to work with people who know a lot about what’s going on in breast cancer, and then bring it to a new level based on what we’re doing, what we’re thinking, and also to field questions, because I learned a lot from the questions I get asked.

What I learned is that it’s a very interactive meeting with high-powered people who have a diversity of opinions. Because it’s multidisciplinary, I might have surgeons who are asking me questions about molecular biology, or you have behavioral scientists who are very interested in the patient experience. It becomes a very multidimensional type of meeting where no matter what you’re presenting, you’re going to be asked questions from many different directions and many different fields. It’s your chance to not only talk about [your interests], but also get input from other people, and maybe talk about something you necessarily [aren’t interested in], or even a pressure point of “Why didn’t this work?” Or, maybe you’re challenged with a question that you don't have the answer to. It’s a good opportunity to express why we don’t have an answer and what we need to do to get an answer.

All those qualities that make this meeting special came to me in a rush at that first encounter. Then I was fortunate enough to get asked again. I [had] said, “Well, I don’t know if I'm going to get asked again.” I knew that [former chair] Daniel A. Osman, MD, creator of MBCC, used to rotate his faculty every other year or something. Some didn’t get asked back. When I got asked back 2 years later, I was glad to be a part of it. Since then, I’ve been coming back regularly and getting an [inside] look at how the meeting operates and how we make it appealing to not only the high-powered scientists but also the clinicians who are seeing patients every day. It’s a unique experience.

Is there one MBCC moment that stands out to you?

One of the most exciting moments was when we got to present some of our work with HER2-targeting therapy because it’s a field that crosses disciplines. Presenting neoadjuvant therapy using biological agents is something that surgeons wouldn’t have dreamed of before—that you’re going to treat a patient who’s ready to go to surgery. They have operable breast cancer, and you’re going to treat them with medical treatment first. We showed the data that we were seeing with treating HER2-positive cancers, which are very responsive to treatment, and seeing it sometimes disappear—melt away—when patients would go to surgery. There was no tumor left. [There was the] notion that we could do that with such a high frequency. There was also the fact that these patients do better and have a lower chance of recurrence, but are also able to undergo less surgery, but more conservative surgery. That was a moment that stuck with me.

It wasn’t just me alone, there were other presentations because many studies were going on during this time. It was a sea change. The very gratifying part of all of this was that the surgeons who were listening were enthusiastic about it. They said, "This is great. We can work with our medical oncology colleagues and be able to offer less surgery and do it as teamwork, coordinate it, be able to see these patients ahead of time before they get treated, and then see them during their treatment and watch it happen."

It brought us together as disciplines a little bit more. We had always been working together and seeing our patients in multidisciplinary tumor boards, but this just took it to another level.

There was the 2019 MBCC, during which the FDA granted an accelerated approval to atezolizumab (Tecentriq) in combination with nab-paclitaxel (Abraxane) for patients with locally advanced or metastatic PD-L1–positive triple-negative breast cancer.¹ That happened in the middle of the conference and faculty had to change up their presentations on the fly!

It was amazing. Atezolizumab got approved right then and there while we were [at the conference], and the data were being [presented].It just gave everybody a sense of how quickly things were happening.

You likely witnessed a lot of patient cases being discussed among attendees looking for outside perspectives. Do you have examples of any solutions to clinical challenges being presented during the meetings?

This happens a lot because we have paradigms and rules that we follow. This treatment works better than that, so this is what we recommend. However, the art of practicing medicine is the exceptional cases—the cases that aren’t straightforward. This doesn’t fit into box A, and it doesn’t fit into box B, so how do we deal with this situation? Those are the ones that are most valuable, and sometimes our audience may ask a question and get 2 different answers from 2 different faculty members. It illustrates the fact that there isn’t a right answer, but there’s a way to think it through, and sometimes thinking it through involves the patient’s point of view. It depends on whether the patient is willing to take treatments that are going to take X amount of time or be subject to this potential [adverse] effect or long-term toxicity. It depends on a test that maybe the physician who was asking the question didn’t know about. There have been times when the person asking the question thought it through and came up with their own answer.

Then there are other times when they recognize that maybe there isn’t a right answer. These are generally well-accomplished clinicians who are asking you these questions, so there’s got to be something complicated about that case. However, when they think it through, and they take the patient’s point of view, and/or maybe listen to some new data that’s come out, that helps them decide. They feel very empowered.

The sense I get from many of the audience members is that they feel happy for the patient—that they’re going to be able to go back and say, "Look, I talked to my colleagues, and this is what we came up with." The patient feels very privileged that their doctor went to this meeting, took their case, and discussed it with a faculty member. We feel good about having been a part of that, too, because all of us are in that situation ourselves. We’re trying to get an answer and, knowing that the patient wants to hear something that’s going to give them the confidence to move forward, is good all-around and very gratifying.

What are your conference plans now for 2025 and beyond? Do you plan to still be involved in the conference, or will you come as an attendee?

I’m sure I’ll still want to come. What I have recognized for a long time is we have many wonderful young faculty who are up and coming [as part of the program agenda]. We have people now that I have known since they were assistant professors are now full professors, chairman of their departments, etc. I’m realizing these are the people who need to be up on the podium and talking—a fresh new group of people. We have so many committee members who are ready to be elevated to cochairs and, ultimately, a chair. It’s a natural progression, and it feels good.

It feels like I’ve done my time here, and I’m ready to sit back and do as I may. If I get invited to come and speak and I can make it, sure, I’ll come. If I can come as an attendee, and just watch, that’s fine as well. However, what is most important is we’re going to get young, talented people taking over, and I‘m sure they’re going to change it and take it in different directions, which is how a meeting should do it. You don’t want it to be static. You want it to be fresh, you want it to be moving. You want it to continue to evolve.

Zeroing in on this year’s meeting, what data or changes to the breast cancer paradigm are you excited to discuss with your colleagues?

Several [treatments or techniques] are cutting-edge and are going to be changing. We have new biological therapies that have recently been approved, that are mutation-specific. You have to sequence the genome, you find a mutation, and you use a targeted drug. We have had the approval of drugs like elacestrant [Orserdu] and capivasertib [Truqap]. We are going to be talking about how to apply those drugs, how to test for them, and what are the genomic aberrations that would lend themselves to being treated with this drug.

There’s another interesting field that has been brought to the forefront now. This is the notion that we can detect DNA in the blood. Of course, we’ve known for years that we can detect tumor DNA in the blood, and we can sequence that DNA and get results without having to do biopsies. Now, these tests have gotten very sensitive; we can pick up a small amount of tumor DNA from a patient who had cancer and is now free of cancer but is maybe in the process of recovering, and now we can see their tumor DNA. We already know that when we can measure it with some of these very sensitive techniques, it increases the risk that they are going to have a true recurrence soon.

Now we’re trying to see if we can do something about it. Can we treat patients and prevent that recurrence in the first place? This is an exciting area, but it also is an area that brings up a lot of controversies for patients participating in the studies, for example. We take a blood sample, and they may not know exactly what they’re getting into, so we feel that we have to inform them as best we can. [We need to explain] that yes, this is a blood test that may give us an answer that we don’t know what to do with because we don’t know what to do when someone has tumor DNA.

The first thing we would do is get a scan and see if there’s something we can see. Many times, you can’t see it because it’s microscopic. It’s just below the threshold of any imaging, and we don’t know how to treat it yet. Now the patient has this information, which is certainly a stressor, and this is sort of an ethical issue. Should we do studies that will put patients in this difficult situation? How can we inform them ahead of time?

We always go through an informed consent process with clinical trials, but this one is a little bit different. There’s the aspirational aspect that we might be able to prevent recurrences in the first place if we can catch them at the very beginning. We have drugs that can work against them, especially targeted drugs, things like immunotherapy, or mutation-specific drugs that might pertain to their tumor. That is another exciting area.

The third thing that is exciting that has gotten better and better every year is our tumor board. We have our tumor board on Thursday, we present complicated cases with our panel of experts, and we take cases from the audience. It is helpful. I learn a lot, our audience learns a lot, and our speakers learn a lot. We’re making treatment decisions based on the state of the art and the newest knowledge that we have. We have one session called the molecular tumor board, which deals with the genomic aberrations that we detect in patients' tumors. How do we manage those? It reflects where the world is in the year 2024. We have come a long way.

Reference

1. FDA approves atezolizumab for PD-L1 positive unresectable locally advanced or metastatic triple-negative breast cancer. News release. FDA. March 8, 2019. Accessed February 9, 2024. https://shorturl.at/uyNP4