Perspectives on Systemic Therapy for Breast Cancer - Episode 14
Adam M. Brufsky, MD, PhD, FACP: This has been a great and really informative discussion. Before we end, I’d like to get the final thoughts from each of our panelists. Francisco, do you have any final thoughts?
Francisco Esteva, MD, PhD: I think it is very useful to review the San Antonio symposium, looking at the different molecular subtypes of breast cancer in the ER-positive populations, CDK4/6 inhibitors, and major advance in breast cancer. In HER2 therapies, there are not major changes. We talked about adjuvant therapies, with neratinib and pertuzumab playing a major role, and in triple-negative disease there is some excitement with antibody drug conjugates and immunotherapy. So, I found the discussion very stimulating. Thank you.
Adam M. Brufsky, MD, PhD, FACP: Komal?
Komal Jhaveri, MD, FACP: I think this was an exciting year for various reasons, including newer drugs coming. We have our first PARP inhibitor approved, for the very first time, for our BRCA-mutant patients. This is exciting, finally. We have exciting new drugs, including the antibody-drug conjugates that we discussed that are very, very novel and very efficacious, at least in the phase II trials. What was also nice was seeing a confirmation of either biases or skepticisms in the early-stage setting and of data specifically focused on subgroups that we would really like to see, including the premenopausal patients for whom we now have the CDK4/6 inhibitor data. I think it was nice to see a confirmation of our biases in certain areas, including ovarian function suppression, so on and so forth, and to have new drugs to offer our patients.
Adam M. Brufsky, MD, PhD, FACP: Great. Hope?
Hope S. Rugo, MD: Of course, I’m just going to mirror what you guys said. I think it’s great to have a discussion and hear what people think about these new studies and new agents, as well as the things that we’ve already known about and are seeing in longer follow-up. But to me, I think the 2 most exciting things in HER2-positive disease are great and we’re learning more about them. But ER-positive disease represents the majority of breast cancer, early and late stage, and CDK4/6 inhibition is just totally exciting. We also have the data on ovarian suppression, finally, after so many years. The whole goal is to cure women, and I feel like ER-positive disease is like locusts: It’s going to survive the nuclear holocaust. We get these people who are still relapsing with stage 1 disease at 15 years. Why are they relapsing? Maybe what we’re learning now is going to help us prevent those late relapses. As for immunotherapy, I worked in the lab 30 years ago on the immune system.
Adam M. Brufsky, MD, PhD, FACP: As we all did.
Hope S. Rugo, MD: We were looking at cytokines and all this. Now, I just feel like it’s made a whole 360-degree turnaround and we are finding a place for immunotherapy in breast cancer, and it’s really exciting. So, I’m excited to see the next few years of data.
Adam M. Brufsky, MD, PhD, FACP: Lee?
Lee Schwartzberg, MD, FACP: Well, it’s hard to be last after my colleagues.
Hope S. Rugo, MD: Last is best.
Lee Schwartzberg, MD, FACP: The only thing I would say is that as a breast medical oncologist, I look forward to San Antonio. It’s my favorite meeting of the year because it invigorates us. We hear the best data. We hear wonderful summaries of where the field is now. I think the science in breast cancer is really making tangible differences in our patients’ lives now, and that’s exciting.
Adam M. Brufsky, MD, PhD, FACP: I agree. That’s a great way to summarize it. Thank you. Thank you all for your contributions to this 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.
Transcript Edited for Clarity