To change — or not to change — clinical practice? That is the question oncologists often find themselves asking after the tsunami of new data washes over them at medical conferences. Even medical conferences limited to a single cancer type, like the San Antonio Breast Cancer Symposium (SABCS), can be overwhelming for attendees. “People leave the meetings often with a conundrum of: ‘What do I take with me?’” Debra Patt, MD, MPH, a medical oncologist and vice president for Texas Oncology, told Cancer Therapy Advisor.
As Cancer Therapy Advisor reported previously, oncologists may decide to change practice based on data presented at medical conferences, despite the data not having been peer-reviewed or published in journal article. The reality is that patients with cancer need better treatments and often cannot wait for a journal article to be published or guidelines to be updated.
When SABCS attendees expressed interest in hearing commentary from none other than Steven Vogl, MD, an oncologist in private practice from New York, and other experts, the conference organizers for SABCS acted. (Dr Vogl is known for his frequent visits to the microphone during the question-and-answer portion of presentations and for his astute questions that follow.)
“The audience needed a commentary from thought leaders as to what they would do based on the data that [were] presented at SABCS,” recalled Virginia Kaklamani, MD, SABCS codirector and professor of medicine, division of hematology/oncology, UT Health San Antonio, Texas, during an interview with Cancer Therapy Advisor. “Many of the oncologists do treat several different cancers, not necessarily [only] breast cancer.”
To provide this needed commentary, the conference organizers created a session during which a multidisciplinary panel of experts would discuss, and put into context, the most important and potentially controversial presentations from the meeting. Since 2016, the session has fallen on a Friday evening, after all the oral presentations have concluded.
The session — which is titled “View from the Trenches: What Will You Do On Monday Morning?” — is not hyperbole. “The idea, ‘What would you change on Monday morning?’, can be real,” Kari Wisinski, MD, medical oncologist with UW Health and the University of Wisconsin Carbone Cancer Center in Madison, Wisconsin, told Cancer Therapy Advisor.
For example, 6-year follow-up results from the APHINITY trial (ClinicalTrials.gov Identifier: NCT01358877) presented at SABCS 2019, on which Cancer Therapy Advisor reported previously, showed that the addition of pertuzumab to adjuvant trastuzumab and chemotherapy particularly benefited patients with node-positive, HER2-positive early breast cancer, regardless of hormone-receptor state.1
In fact, session panelist Dr Patt encouraged attendees to add pertuzumab to adjuvant trastuzumab and chemotherapy for patients with node-positive disease but not for those with node-negative disease, given that the study showed no benefit for these patients.
The session also serves to help oncologists recognize when not to change practice on the basis of presented data. For example, the ATEMPT trial (ClinicalTrials.gov identifier: NCT01853748) evaluated whether patients with stage I HER2-positive disease could benefit from de-escalated adjuvant therapy with trastuzumab emtansine (T-DM1).2
Although the trial showed that patients who received T-DM1 had a low rate of recurrence, it did not show less toxicity than adjuvant paclitaxel plus trastuzumab. Dr Patt cautioned against making T-DM1 the standard of care, explaining that the trial had short follow-up, T-DM1 had high discontinuation rates, and T-DM1 has a high financial cost.