Adam M. Brufsky, MD, PhD
As investigators increase their understanding of the biology of triple-negative breast cancer (TNBC), new approaches are emerging that could optimize patient outcomes.
State of the Science Summit™ on Breast Cancer, Brufsky, professor of Medicine, associate chief, Division of Hematology/Oncology, co-director, Comprehensive Breast Cancer Center, associate director, Clinical Investigation, University of Pittsburgh, highlighted novel treatment approaches being explored in the TNBC space.
OncLive: Could you provide an overview of your presentation on treatment approaches in TNBC?
: What I talked about today had to do mostly with the genomic assays for breast cancer—in particular, the 21-Gene recurrence score assay, which is Oncotype DX, and the 70-gene signature test, which is MammaPrint. I compared and contrasted 2 of the large randomized clinical trials that have been done—TAILORx for Oncotype DX and MINDACT for MammaPrint.
They both were interesting; it’s gratifying that they both measure the same thing; they identify a group of patients who do not require chemotherapy. In the case of TAILORx, it’s really for node-negative breast cancer, while with MammaPrint in the prospective trial, it was node-negative and node-positive disease. There will be node-positive data coming out from a trial called RxPONDER in the next few years as well.
What treatment approaches are being evaluated for patients with TNBC?
In TNBC, we are going to talk about the new data on checkpoint inhibitors, which are really exciting, especially for patients who are PD-L1 positive. Patients who are given these inhibitors have been shown to have a 2-year overall survival, which is double that of not having had the checkpoint inhibitor—that is really dramatic.
In my presentation, I spoke a bit about sacituzumab govitecan, which is an antibody-drug conjugate to the Trop-2 antigen; it also has a lot of exciting phase II data in the third-line setting and beyond in TNBC. A large randomized phase III trial is currently ongoing that is randomizing patients to receive either sacituzumab govitecan or the standard of care in TNBC, which is generally chemotherapy. This is exciting new research.
I also discussed the use of PI3K inhibitors in patients with TNBC. There’s a trial called PAKT, where women who had PI3K-, AKT-, or PTEN-mutated breast cancer were randomized to receive paclitaxel with or without the AKT inhibitor [AZD5363], and they had an overall survival benefit as well if they had a PI3K mutation.
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