Debu Tripathy, MD
Debu Tripathy, MD, professor of medicine and co-leader of the Women’s Cancer Program at the University of Southern California Norris Comprehensive Cancer Center, was one of four co-chairs of the 2012 Miami Breast Cancer Conference.
Tripathy described the conference as especially valuable because of the multidisciplinary perspective that infused this year’s program. He sat down with Oncology & Biotech News to speak about how collaboration among disciplines has led to intriguing new findings in breast cancer research that are driving progress in his field.OBTN: As a long-time attendee of other major breast cancer meetings, and now one of the co-chairs of the Miami Breast Cancer Conference, can you discuss the features that set this meeting apart from other breast cancer conferences?Dr Tripathy:
The Miami Breast Cancer Conference has always had a unique niche among the conferences about breast cancer that occur globally each year. It started off as an opportunity for surgeons to learn more about biology and other disciplines, but over the years the Miami Breast Cancer Conference has become a multidisciplinary conference. Most importantly, it creates a bridge between the basic sciences and all the clinical disciplines. Not only is there an interaction between experts in the field of radiology, pathology, and surgical/ medical/radiation oncology, but basic scientists provide a biological perspective that is becoming increasingly important in the management of breast cancer. When you think about where we are today, a breast cancer physician has to be a biologist, a statistician, a psychologist, and a clinician. So understanding the molecular events that drive the development of breast cancer will become more important for physicians in formulating diagnostic and therapeutic plans and effectively communicating these to patients.
How does the medical oncologist decide who needs chemotherapy for a low-risk lesion? How do we combat the problem of drug resistance? How do we make sure that our surgical margins are truly negative and are going to result in the lowest local recurrence? How do we decide what type of radiation field to use that maximizes the benefit and minimizes the toxicity? The key to finding these answers lies both in the discoveries of basic science as well as in the level of evidence that is being built from clinical trials. This is precisely what this conference brings together for the clinicians: a perspective that spans the biology, the statistics, the clinical evidence, and the behavioral and psychological issues that our patients are dealing with in making decisions.How does this meeting address these issues in a way that’s meaningful for each specialist?
We have speakers and audience members from every specialty, including medical, surgical, radiation oncology, medical genetics, behavioral psychology, radiology, pathology, biostatistics, and, of course, the basic sciences. I’m a medical oncologist by training, but one of the things that drew me to the field of breast cancer was its incredible intellectual richness—from the basic sciences to all the different disciplines—and a way to take that and apply it to the patients for whom we care. In the area of medical oncology, we are increasingly dependent on our basic science colleagues to point us in the direction of how new therapies work and how to choose the appropriate patients for specific therapies. We also have to work closely with our pathologists to understand the biomarker landscape of the tumors so we can choose the best treatment, and with our surgical colleagues so that they can communicate ahead of time to the patient what systemic treatments might be needed after surgery.
I find that, as a medical oncologist, this conference allows me to interact with my colleagues in a very real-life way—the way that I work in my own practice, where I am in constant touch with my colleagues regarding input that I might need from the different specialties, and then, of course, integrating this all into an effective decision-making exercise.What important highlights are being presented at this year’s Miami Breast Cancer Conference that have the potential to affect treatment and treatment decisions?
In adjuvant therapy, the use of molecular profiling to make decisions regarding the benefit of chemotherapy when added to hormonal therapy for hormone receptor-positive and HER2-negative disease is an ongoing story. We now have established reasonably well that, for node-negative breast cancer, we can identify subgroups of patients that are more likely to benefit from chemotherapy. This has always been an important area, because the benefits overall in node-negative cancer are very small. We’ve always wondered whether there may be a subgroup of patients that’s really deriving the lion’s share of the benefit. In fact, we now know this is the case.