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Pivotal Findings Lead to Changing Standards of Care in Breast Cancer

Gina Columbus @ginacolumbusonc
Published: Sunday, Feb 03, 2019

Denise Yardley, MD

Denise Yardley, MD

The encouraging findings with the alpha-specific PI3K inhibitor alpelisib in patients with PIK3CA-mutant breast cancer coincide with the refined, personalized approach being implemented in breast cancer treatment, explained Denise A. Yardley, MD.

State of the Science Summit™ on Breast Cancer, Yardley, senior investigator, Breast Cancer Research Program, Sarah Cannon Research Institute, discussed key data presented at the 2018 SABCS and the impact of the SOLAR-1 findings.

OncLive: What would you define as the most practice-changing studies from the 2018 SABCS?

Yardley: SABCS continues to build on a changing standard of practice for patients facing a diagnosis of breast cancer. What we are continuing to see, as a big message, is trying to define our treatment recommendations. For early-stage patients, it is trying to decide on which patients need chemotherapy, who can avoid chemotherapy, and then for those who are going to benefit from endocrine therapy, [who should receive] the extended endocrine therapy. We are seeing not the one-size-fits-all approach anymore; it’s really tailoring it on a case-by-case basis. In my practice, my discussions become longer and longer trying to assimilate the data and bring the patients into that patient-physician partnership to try to make these treatment decisions. 

We saw exciting data with immunotherapy for the first time—we saw that enter the realm of breast cancer with a strong signal. I have had partners in our practice at Sarah Cannon Research Institute that have a longstanding history in lung cancer with immunotherapy. But now, breast cancer actually rocks with immunotherapy. That is confined to triple-negative breast cancer (TNBC) in the first-line setting. On top of that, it is for PD-L1–positive tumors. Therefore, we are really learning to tailor our treatment recommendations for different subtypes and the precision of different mutations in breast cancer. Making those treatment decisions are really hinging on having those data available. 

Are more patients in your practice inquiring about immunotherapy following the IMpassion130 data? 

I see patients really struggling with the data. Various patients come in with newspaper clippings, and all have some pertinence to immunotherapy—whether it’s a signal or whether it’s as bench work in the basic science labs. It is more challenging to explain to them why this [class of] drugs, which are approved in many other solid tumors, has been struggling in breast cancer. I take the dialogue that breast cancer is not a one-size-fits-all [approach]. There are multiple subtypes, and the biology of these subtypes are very well etched out; we are seeing how therapies work and don’t work in these specific subtypes. 
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