William J. Gradishar, MD
Over the last 2 decades, the treatment paradigm of breast cancer has significantly evolved, according to William J. Gradishar, MD, chair of the 20th Annual Lynn Sage Breast Cancer Symposium.
During the Lynn Sage Distinguished Lecture at the symposium, he addressed some of the biggest advancements in breast cancer, while also pointing out a few developments that did not pan out as hoped. Overall, the field has advanced significantly, particularly in the HER2-positive subtype.
“Twenty years ago, we were just starting to appreciate that [HER2 positivity] was a distinct entity,” Gradishar said. “And even though we didn’t necessarily recognize it, we didn’t really have much in the way of therapy than any other kind of breast cancer.”
Now therapeutic options for these subtypes and others of breast cancer have moved the needle forward. Some of the most practice-changing additions Gradishar discussed are combination therapies, anti-hormonal agents, and checkpoint inhibitors.
In an interview with OncLive
, Gradishar, chief of hematology and oncology in the Department of Medicine, Betsy Bramsen Professorship of Breast Oncology, and professor of medicine, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, discussed how far the breast cancer field has advanced over the last 20 years and the data he is anticipating in the future.
OncLive: Could provide an overview of how treatment for patients with breast cancer has evolved?
: When we started the symposium 20 years ago, it almost perfectly corresponded when the National Comprehensive Cancer Network (NCCN) guidelines started as an institution—as an enterprise—to develop evidence-based guidelines. I thought that would be a nice starting point for my lecture. Then, I reflected on how things have changed over the last 20 years.
There have been things that we thought were going to be extraordinarily promising that turned out to be busts, and I revisit some things like that, with respect to bone marrow transplant, endogenous inhibition, a variety of different things. One of the themes that came up in my talk was that we have made remarkable progress. We haven’t necessarily hit home runs, with respect to changing the course of how we approach patients with either early- or late-stage breast cancer. In this case, how I approached my talk is from the medical oncologist’s standpoint.
The things we thought were going to be extraordinarily promising, [which could] basically put an end to our careers, really didn’t come to pass. What we have seen has been steady incremental improvement in terms of outcome, steady improvement in the number of options patients have, and by extension, many more possibilities for optimizing patients with both early- and late-stage disease. I highlighted the different buckets of breast cancer, how we have evolved away from chemotherapy, and even though chemotherapy still remains foundational, we have probably maxed out on what it can accomplish. Now, we focus on the incremental and steady improvements in antihormonal therapy, anti-HER2 therapy, and then of course, the promise of new therapies that will be coming along, including immunotherapies.
What kind of developments have you found to be the most significant?
Over the last 20 years, we have seen an area of breast cancer that didn’t exist 20 years ago, which is HER2-positive disease. We have seen an explosion of therapeutic options for patients that resulted in a completely different way that the disease is treated. Furthermore, it has improved the outcomes remarkably, both in patients with advanced- and early-stage disease.
Similarly, for antihormonal therapy, we had a couple of options 20 years ago, but the number of options has expanded significantly. The thing that has changed the most recently is partnering anti-hormonal therapy with targeted therapy, which has resulted in markedly improved outcomes. These kinds of therapies are now making their way into the adjuvant setting of estrogen receptor–positive breast cancer.