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Final Thoughts on Advanced Breast Cancer

Panelists:Adam M. Brufsky, MD, PhD, University of Pittsburgh Cancer Institute;Carlos L. Arteaga, MD, Vanderbilt University;Kimberly L. Blackwell, MD, Duke University Medical Center;Joyce A. O’Shaughnessy, MD, Baylor Charles A. Sammons Cancer Center;Sunil Verma, MD, MSEd, FRCPC, University of Calgary
Published: Tuesday, Sep 20, 2016


Transcript:

Adam M. Brufsky, MD, PhD:
This has really been extremely informative. We’ve discussed several important scenarios in the management of HER2-positive, HR-positive, ER-positive, and triple-negative breast cancer. Before we end this discussion, I’d like to get some final thoughts from our panelists. So, Dr. Arteaga, any final thoughts?

Carlos L. Arteaga, MD: My final thoughts are that this is a very exciting time in breast cancer. There has never been more momentum for progress in terms of our understanding of the genomic drivers of breast cancer and for the fact that we need to use combination therapies preferably early in the natural history of the disease. And, I think we’re going to be seeing increasing progress in the years to come.

Adam M. Brufsky, MD, PhD: Very good. Thank you. Joyce.

Joyce A. O’Shaughnessy, MD: I’ll just mention briefly the FinXX data, the 10-year follow-up on the FinXX trial adding adjuvant capecitabine to an ACT backbone in the triple-negative subset analysis. Certainly not statistically powered nor prospective, I don’t believe, but showing a big benefit on disease-free survival—corroborating the CREATE-X trial that came out and showed that if you didn’t get a pathologic CR in a triple-negative tumor, 6 months of capecitabine was beneficial. It was also in the FinXX trial, six cycles of capecitabine. So, still we need the CREATE-X published; FinXX was a subset analysis. We showed in a subset analysis, once again, in the adjuvant setting with capecitabine, a survival advantage as well. I think that because triple-negative breast cancer is a disease that in high-risk needs additional therapeutic options, it’s not unreasonable to consider capecitabine for patients. But, just to put those data out there because they were highlighted at ASCO this year.

Adam M. Brufsky, MD, PhD: Right, I agree. I think the role of capecitabine in the adjuvant therapy is increasing, and we really need to see those data published to get a better sense of where we’re going to go with that. Kim.

Kimberly L. Blackwell, MD: I agree with Joyce. I think at this year’s meeting in particular, I’m excited about hopeful drugs for heavily pretreated triple-negative and even ER-positive. So, with the CDK (cyclin-dependent kinase) inhibitors, we’re seeing data with several of the ADCs (antibody-drug conjugates) at this year’s meeting, the specific targets that we haven’t heard about before. I think for me, this year’s meeting really offers some hope that over the next year or two, we’re going to have lots of different options for heavily pretreated metastatic breast cancer.

Adam M. Brufsky, MD, PhD: Good. Sunil.

Sunil Verma, MD, MSEd, FRCPC: I think the key takeaway is for early-stage breast cancer, adjuvant chemotherapy, what we were doing before has been confirmed by a very well conducted ABC trial. For the adjuvant endocrine setting, more is better at the present time, and extended therapy is important. In ER-positive, it’s nice to see the confirmed PALOMA-2, based on our PALOMA-1 suspicion. And for HER2-positive, I think we’re really in the seesaw battle. Who do we give more treatment to, who do we give less treatment to? So, we’re kind of balancing that. And, yes, in triple-negative breast cancer there are some really exciting drugs with the ADCs which show some very promising activity. It’s going to be in a very sub-grouped type of disease. It’s been a great ASCO.

Adam M. Brufsky, MD, PhD: Super. And, just one last thing for me. I think that—again, we didn’t have time to talk about it here—one of the things that really struck me about MINDACT, which was a trial using a genomic aspect prospectively to determine who should get chemotherapy or hormone therapy alone, is that the most common patients we see who are ER-positive, 0 to 3 node positive patients, probably represent 60%, 70% of what the average oncologist will see worldwide. In that study, regardless of what you think of how the genomic test operated—which I thought was actually pretty good—the 5-year metastasis-free survival was almost 92%. And that tells us we’re doing something pretty good. I think that with breast cancer, we’ve got a lot of great stuff going on, a lot of really cool things for metastatic disease. But, in the average bread and butter patient with early-stage breast cancer, I think we can say we’re at a point where we weren’t 25, 30 years ago. I think we’ve really done an incredibly good job. We need to do better, obviously, but I think we’ve done really, really well. So, for that, I thank you again for all your contributions to the discussion. On behalf of our panel, we thank you for joining us and we hope you found this peer exchange discussion to be useful and informative. Again, thank you very much and thank you for listening to us.

Transcript Edited for Clarity
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Transcript:

Adam M. Brufsky, MD, PhD:
This has really been extremely informative. We’ve discussed several important scenarios in the management of HER2-positive, HR-positive, ER-positive, and triple-negative breast cancer. Before we end this discussion, I’d like to get some final thoughts from our panelists. So, Dr. Arteaga, any final thoughts?

Carlos L. Arteaga, MD: My final thoughts are that this is a very exciting time in breast cancer. There has never been more momentum for progress in terms of our understanding of the genomic drivers of breast cancer and for the fact that we need to use combination therapies preferably early in the natural history of the disease. And, I think we’re going to be seeing increasing progress in the years to come.

Adam M. Brufsky, MD, PhD: Very good. Thank you. Joyce.

Joyce A. O’Shaughnessy, MD: I’ll just mention briefly the FinXX data, the 10-year follow-up on the FinXX trial adding adjuvant capecitabine to an ACT backbone in the triple-negative subset analysis. Certainly not statistically powered nor prospective, I don’t believe, but showing a big benefit on disease-free survival—corroborating the CREATE-X trial that came out and showed that if you didn’t get a pathologic CR in a triple-negative tumor, 6 months of capecitabine was beneficial. It was also in the FinXX trial, six cycles of capecitabine. So, still we need the CREATE-X published; FinXX was a subset analysis. We showed in a subset analysis, once again, in the adjuvant setting with capecitabine, a survival advantage as well. I think that because triple-negative breast cancer is a disease that in high-risk needs additional therapeutic options, it’s not unreasonable to consider capecitabine for patients. But, just to put those data out there because they were highlighted at ASCO this year.

Adam M. Brufsky, MD, PhD: Right, I agree. I think the role of capecitabine in the adjuvant therapy is increasing, and we really need to see those data published to get a better sense of where we’re going to go with that. Kim.

Kimberly L. Blackwell, MD: I agree with Joyce. I think at this year’s meeting in particular, I’m excited about hopeful drugs for heavily pretreated triple-negative and even ER-positive. So, with the CDK (cyclin-dependent kinase) inhibitors, we’re seeing data with several of the ADCs (antibody-drug conjugates) at this year’s meeting, the specific targets that we haven’t heard about before. I think for me, this year’s meeting really offers some hope that over the next year or two, we’re going to have lots of different options for heavily pretreated metastatic breast cancer.

Adam M. Brufsky, MD, PhD: Good. Sunil.

Sunil Verma, MD, MSEd, FRCPC: I think the key takeaway is for early-stage breast cancer, adjuvant chemotherapy, what we were doing before has been confirmed by a very well conducted ABC trial. For the adjuvant endocrine setting, more is better at the present time, and extended therapy is important. In ER-positive, it’s nice to see the confirmed PALOMA-2, based on our PALOMA-1 suspicion. And for HER2-positive, I think we’re really in the seesaw battle. Who do we give more treatment to, who do we give less treatment to? So, we’re kind of balancing that. And, yes, in triple-negative breast cancer there are some really exciting drugs with the ADCs which show some very promising activity. It’s going to be in a very sub-grouped type of disease. It’s been a great ASCO.

Adam M. Brufsky, MD, PhD: Super. And, just one last thing for me. I think that—again, we didn’t have time to talk about it here—one of the things that really struck me about MINDACT, which was a trial using a genomic aspect prospectively to determine who should get chemotherapy or hormone therapy alone, is that the most common patients we see who are ER-positive, 0 to 3 node positive patients, probably represent 60%, 70% of what the average oncologist will see worldwide. In that study, regardless of what you think of how the genomic test operated—which I thought was actually pretty good—the 5-year metastasis-free survival was almost 92%. And that tells us we’re doing something pretty good. I think that with breast cancer, we’ve got a lot of great stuff going on, a lot of really cool things for metastatic disease. But, in the average bread and butter patient with early-stage breast cancer, I think we can say we’re at a point where we weren’t 25, 30 years ago. I think we’ve really done an incredibly good job. We need to do better, obviously, but I think we’ve done really, really well. So, for that, I thank you again for all your contributions to the discussion. On behalf of our panel, we thank you for joining us and we hope you found this peer exchange discussion to be useful and informative. Again, thank you very much and thank you for listening to us.

Transcript Edited for Clarity
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TitleExpiration DateCME Credits
Community Practice Connections™: CDK4/6 Inhibitors With the Experts: The Role of Emerging Agents for the Management of Metastatic Breast CancerMay 30, 20182.0
Medical Crossfire®: Clinical Updates on PARP Inhibition and its Evolving Use in the Treatment of CancersMay 30, 20181.5
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