This year we are celebrating the 20th anniversary of our flagship publication OncologyLive
. To mark the occasion, we are asking oncology leaders to reflect on the tremendous progress made in cancer research and practice over the past 2 decades. Here are insights from 4 of the top thought leaders in the field of breast cancer.
MARK D. PEGRAM, MD
Stanford Women’s Cancer Center
HOW HAS BREAST
Mark D. Pegram, MD
cancer treatment changed in 20 years? Night and day. We can now sequence whole genomes in breast tumors. We can measure allelic frequencies of particular mutations. It’s been a sea change in technology. The intrinsic subtypes of breast cancer were discovered at Stanford based on gene expression technology, which was pioneered at my institution back in the early 2000s. We didn’t know there were different intrinsic subtypes; as clinicians, we knew they must exist, because some patients did very well with standard treatment in early-stage disease and some relapsed and died of early-stage breast cancer—and still do, to this day. The question was always “Why?”
Back when I first started my training, we treated most people based on their stage and steroid-receptor status and that was about it. And then came HER2 and the first biologic agent ever approved for breast cancer, trastuzumab. There have been changes in the treatment of hormone-receptor positive breast cancer. Look at the multigene testing platforms that are commercially available; all those platforms are, ultimately, based on gene expression array technology. The multigene platforms can now [identify] groups with such good prognosis that they don’t need chemotherapy. That was a huge change in the practice of breast cancer, and I saw it during my lifetime. I never expected to see that kind of classification of human breast cancer—to such granularity. That is just the first generation of the multigene test. There will be future generations exploiting this kind of new genomic age technology, which will divide breast cancer in to more granular subsets that no doubt will have both prognostic and predictive value in those categorizations.
WILLIAM J. GRADISHAR, MD, FASCO
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