Hope Rugo, MD, On the Future of Breast Cancer Treatment


The breast oncologist from the University of California, San Francisco, discussed new agents being developed in the breast cancer space.

Hope Rugo, MD, breast oncologist at University of California, San Francisco, spoke about what we can look forward to in breast cancer treatment at the 37th Annual Miami Breast Cancer Conference, held from March 5-8, 2020 in Miami, Florida. 


Well, I think there’s so many things going on. I mean, we’re really looking forward to the adjuvant data with CDK4/6 inhibitors we hope to see soon. We’re looking for event-free survival in the KEYNOTE-522 trial. More trials with immunotherapy so we understand it more in both within the adjuvant, neoadjuvant, and metastatic setting. We’re looking for sacituzumab govitecan (IMMU-132) to be approved this year in triple negative breast cancer. There’s an ongoing trial in hormone receptor positive disease called TROPICS which that is enrolling quickly and hopefully that will be another option as well, and then to rapidly move this agent into the high-risk, you know, poorly responsive neoadjuvant or adjuvant setting is of course a big goal, because we want to cure people if we can. 

We’re also, I’m also really interested in some of the trials that we were talking about with, say, T-DM1 (Kadcyla) and tucatinib, T-DM1 being compared to DS-8201, the trastuzumab deruxtecan (Enhertu). And then, I think, you know, there are a lot of trials looking at other targeted agents. In hormone receptor positive disease, I think the AKT inhibitors are really intriguing and maybe a less toxical option. There’s oral selective estrogen receptor downregulators, maybe we’ll see some effectiveness, there’s a [selective estrogen receptor modulator; SERM], like tamoxifen (Soltamox), called lasofoxifene (Fablyn) that seems to have a lot of activity in patients who have ESR1 mutations, really an exciting area as well that’s being studied in an ongoing trial.

And then, you know, the trastuzumab deruxtecan had some data in HER2-low disease. So, it’s sort of a new area. So that’s being studied as well, those are patients who have 1 plus 2 plus but not FISH amplified disease. There’s a second antibody drug conjugate that, made by a company called Synthon, that has an alcolater toxin, so it’s quite different from the Topo inhibitor that’s being used for, in trastuzumab deruxtecan. That’s being in a phase III trial in HER2-positive disease, but also hopefully will be studied in HER2-low disease as well, where they’ve also seen efficacy, potentially in a neoadjuvant setting, it’s hard to know.


So, I think that that’s, you know, exciting data where we’re not just… and the biggest subtype of patients we see are not triple negative or HER2-positive actually, they’re patients with hormone receptor positive disease. We see a lot of late recurrences, so, you know, trying to better understand how to optimally treat hormone receptor positive disease is really a critical issue and I think we’re seeing some studies that will come up in the near future that will help us some with that. 

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