Ruth O'Regan, MD
Endocrine therapy has long been a standard approach for patients with estrogen receptor (ER)-positive breast cancer, but there is an unmet need for the patients who develop resistance to this treatment.
, O’Regan discussed the current landscape of HR-positive breast cancer and the unanswered questions that still need to be addressed.
OncLive: What are the updates in HR-positive breast cancer treatment?
: The most dramatic thing that has happened in ER-positive breast cancer is that most patients do not need chemotherapy. More than 70% of patients with ER-positive, node-negative breast cancer do not need chemotherapy. From the TAILORx study led by Dr Joseph Sparano, what we know is that women under the age of 50 benefit from chemotherapy if they have recurrence scores over 16. Therefore, the question is, “How can we manage those patients?” If we are going to give them chemotherapy, there are several trials suggesting that you can use a less aggressive regimen.
Lastly, whatever we find works in the metastatic setting, we want to try to test that in an earlier treatment setting. There are several studies looking at CDK4/6 inhibitors and we await the results of those.
If approved in an early-stage breast cancer setting, how will CDK4/6 inhibitors impact sequencing?
Right now, the CDK4/6 inhibitors are not being used for early-stage breast cancer. There are some preoperative data suggesting they can increase tumor response using Ki-67 when given with endocrine therapy, but there are not yet any data in the early settings. When there are data, and if these agents are approved, that it is going to be a really interesting question.
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