The 10th International Congress on the Future of Breast Cancer was held in Coronado, California, August 4-7, 2011. The 4-day, interactive program was developed and chaired by leading breast cancer researcher Joyce A. O’Shaughnessy, MD, a medical oncologist with Texas Oncology-Baylor Charles A. Sammons Cancer Center in Dallas.
Our editors had a unique opportunity to sit down with Dr O’Shaughnessy to discuss the goals of the meeting—namely, to increase our understanding of the biologic subtypes of breast cancer—and to get her perspective on how the hypotheses and data are evolving in this dynamic field.
OBTN: This 2011 meeting marks the tenth year of The International Congress on the Future of Breast Cancer. The 10th anniversary is typically associated with tin or aluminum, signifying pliability and durability—the ability to bend, but not break. Looking back on the past 10 years, there have certainly been a few bends in the road. Can you talk a little about how the field of breast cancer research—and this meeting specifically—has evolved over the past decade?
As I remember back to the very first meeting, I think the main thing I recall is that Carlos L. Arteaga, MD, gave a very good talk about the role of the HER (ERBB) family in breast cancer and the interconnectedness between the HER receptors and downstream proteins. There was an incredible sense of excitement at that time about us being able to start to tease out resistance mechanisms to therapy and really have a handle on what some of the deadly pathways were for patients who had aggressive breast cancer.
That’s the kind of information that I try to bring to this meeting—the cutting edge, new mechanistic, pathogenetic mechanisms—because that’s what physicians are so eager to learn about. This area has just grown over the years as we’ve become increasingly mechanistic in our understanding of the various subtypes of breast cancer. So, this meeting focuses primarily on the various biologic subtypes of breast cancer; our understanding of these subtypes has increased significantly since we first started meeting 10 years ago.
The meeting draws an international and an interdisciplinary audience. How does this year’s program manage to address this level of diversity in the attendees?
We really focus more on what all breast cancer practitioners need around the world: a better biologic understanding of the disease, better diagnostics, and better therapeutics. So, we don’t focus on the clinical needs of the international audience, per se. The informational needs in breast cancer are universal, that is to really understand this disease and make better therapeutics. We have experts from around the world who are as interested in breast cancer as people in the United States, and so they come to this meeting because it’s a way to get a focused update on all the important clinical information, and to see how the hypotheses and data are evolving with regard to the patients they’re taking care of right now.
You participated in the FDA hearings on Avastin. In a nutshell, the real issue seemed to be that the drug showed improvement in progression-free survival but was unable to demonstrate a benefit in overall survival. In your opinion, what is the most meaningful endpoint to demonstrate an unequivocal benefit to the patient? How much improvement/benefit is enough? What should be the standard going forward?
The front-line Avastin trials in metastatic breast cancer—3 large, randomized trials—all met their primary endpoint of progression-free survival. They did not meet the endpoint of overall survival, but that wasn’t their primary endpoint. Nor were these trials really powered for survival in terms of picking up small benefits. So, I think that the primary endpoint for approval for Avastin and other first-line therapies should be progression-free survival.
I think that if you have a statistically significant finding and you meet your primary endpoint, the drug should be approved. Then it’s up to the oncology community to decide whether the magnitude of benefit is large enough to warrant the risks versus the benefits. I think Avastin in first-line therapy for metastatic breast cancer is very safe, as physicians are now accustomed to avoiding Avastin use in patients who have the possibility of complications (ie, patients with recent surgery, diverticulitis, any kind of active wound in the body, or with baseline uncontrolled hypertension).