The third area that is exciting is we are still seeing a robust flow of data from new agents that are in development. We are seeing many trials focusing on the immune system and how to best stimulate it or reprogram it to fight cancer with a lot of promise. There are many other agents for other pathways that are being explored. We need to understand the biology of the tumor and the patient, and then focus the treatment that way. Hopefully, those achievements will continue year after year.
Moving forward, what role will immunotherapy have in the treatment of patients with HER2-positive breast cancer?
The idea of using, or reprogramming, the immune system or stimulating it to fight cancer has been a dream that many people were following. The introduction of checkpoint inhibitors in many cancers over the last few years has been making a difference for the treatment of patients with cancer.
In breast cancer, there has been a robust interest in the immune system and immuno-oncology agents. Due to the clinical unmet need in triple-negative breast cancer, there is a focus of immunotherapy there because, biologically, those tumors have a higher mutational load and are more immunogenic. There is also interest in other subsets of breast cancer like ER-positive breast cancer.
There is going to be a role for immunotherapy for HER2-positive breast cancer. There are many agents that are being studied in several settings and in combination with other agents. We will see that there is a subset of patients with breast cancer who benefit from immunotherapy. Who those patients are with HER2-positive disease is something that remains to be determined based on our understanding of the biology and the impact the treatment is making. I am optimistic that the future of immune-oncology is bright.
Fehrenbacher L, Cecchini RS, Geyer CE, et al. NSABP B-47 (NRG Oncology) phase III RCT comparing adjuvant chemotherapy ACweekly paclitaxel (WP) or TC x 6 with or without trastuzumab for 1 year in high-risk, invasive breast cancer, negative for HER2 by ISH and with IHC 1+ or 2+ (HER2-Low IBC). Presented at: SABCS; December 5-9, 2017; San Antonio, Texas.