Please login or register first to view this content.
Next Steps in Breast Cancer Treatment: Observations From the ASCO20 Virtual Scientific Program |
Practice Community
Pittsburgh, Pennsylvania
Practice Niche
Breast Cancer
Hospital and Institutional Affiliations
Associate Director of Clinical Investigation and Co-Director of the Comprehensive Breast Cancer Center at the University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center
Professor of Medicine and Associate Chief in the Division of Hematology/Oncology at the University of Pittsburgh School of Medicine
This interview has been edited for length and clarity.
Question What were the most important takeaways from the plenary session during the ASCO20 Virtual Scientific Program as they relate to breast cancer? What did the results from the phase 3 ECOG-ACRIN study1 tell oncologists about the potential role of local therapy in de novo, stage IV metastatic disease? |
Answer There are some caveats in this trial and its design, but the most important thing was the finding that when you do early surgery it doesn’t affect survival. Breast cancer is a systemic disease at diagnosis. We knew this in early breast cancer and we know it in metastatic disease.
|
Question It has been suggested that the presentation on TRAIN-2 could have practice-changing results in HER2-positive early breast cancer, and that the data appear to show that anthracyclines can safely be omitted from regimens in this patient population.2 What is your view on the results of this trial? |
Answer The trial assigned women to FEC (5-fluorouracil, epirubicin, cyclophosphamide) for 3 cycles followed by [paclitaxel, trastuzumab, and carboplatin plus pertuzumab] for 6 cycles or [paclitaxel, trastuzumab, and carboplatin plus pertuzumab] at the same dose and schedule as in the anthracycline group for 9 cycles. |
Question In patients with previously untreated, locally recurrent, inoperable or metastatic triple-negative breast cancer (mTNBC) whose tumors expressed PD-L1, the receipt of pembrolizumab plus chemotherapy was shown to improve progression-free survival compared with chemotherapy alone.3 How do these results, as well as the overall survival (OS) results from KEYNOTE-355, contribute to the understanding of first-line immunotherapy plus chemotherapy in mTNBC? |
Answer KEYNOTE-355 shows essentially similar results as IMpassion130. About 40% of patients (similar to the 40% that are PD-L1–positive in IMpassion130) had [a combined positive score] of greater than or equal to 10. These patients had a median PFS of 9.7 months with chemotherapy and pertuzumab vs 5.6 months with chemotherapy alone (HR, 0.65). |
Question Do the results seen in PHERGain help oncologists decipher which patients with HER2-positive early breast cancer may be best positioned to achieve a pathologic complete response (pCR) with trastuzumab plus pertuzumab treatment — and also, which patients may avoid chemotherapy altogether?4 |
Answer The investigators treated women with HER2-positive early-stage breast cancer with either standard neoadjuvant chemotherapy (TCHP) or trastuzumab plus pertuzumab for 2 cycles, or with endocrine therapy if the cancer was ER-positive. If the patients had a response by PET/CT, they continued this therapy. If they did not, they were shifted to TCHP.
|
Question Please discuss the final results of the BYLieve trial in hormone receptor-positive (HR+), HER2-negative, PIK3CA-mutated advanced breast cancer. In patients whose disease regressed either while receiving treatment or after prior therapy, was there compelling evidence for the subsequent efficacy of alpelisib plus fulvestrant, in your view? |
Answer The idea behind BYLieve was to expand on what to do after progression on a CDK 4/6 inhibitor. Here, they looked at a cohort who had a CDK 4/6 inhibitor and an [aromatase inhibitor] and were given alpelisib plus fulvestrant. |
References
Please login or register first to view this content.