Summary
The field of oncology has seen a number of major breakthroughs in recent years and the breast cancer space is no exception.
“From screening and prevention to management of early and advanced stages and survivorship considerations, many advances have been made in breast cancer treatment,” noted Sramila Aithal, MD, a hematologist and medical oncologist at Cancer Treatment Centers of America, Philadelphia.
To explore additional resources offered by Oncology Times and to subscribe, visit https://journals.lww.com/oncology-times/pages/default.aspx
Original Article
A Look at the Latest Trends & Breakthroughs in Breast Cancer
Oncology Times
By Catlin Nalley
The field of oncology has seen a number of major breakthroughs in recent years and the breast cancer space is no exception.
“From screening and prevention to management of early and advanced stages and survivorship considerations, many advances have been made in breast cancer treatment,” noted Sramila Aithal, MD, a hematologist and medical oncologist at Cancer Treatment Centers of America, Philadelphia.
This includes a shift towards less invasive and more personalized treatments. For instance, early-stage breast cancer saw improvement with de-escalating therapy, according to Aithal.
“Identifying tumors that are of low risk clinically and by genomic assessment, thereby avoiding chemotherapy and its side effects, has helped more than 60,000 women each year,” she said. “Using less toxic and minimal chemotherapy and anti-HER2/neu therapy in early-stage HER2-positive breast cancer has proven to improve disease-free survival.”
With an emphasis on tumor biology, therapy for breast cancer has become more tailored and nuanced, explained Anees B. Chagpar, MD, MSc, MPH, MA, MBA, FRCS(C), FACS, Professor in the Department of Surgery at Yale University School of Medicine.
“We now have assays to predict which patients will benefit from adjuvant therapy; and patients who otherwise would have been treated in a ‘one-size-fits-all’ fashion are now receiving treatments that are more suited to their individual tumors,” she told Oncology Times.
Latest Discoveries
There have been a number of discoveries across the field of breast cancer, leading to improved outcomes for patients.
“Immunotherapy continues to be an exciting development, particularly in the triple-negative space, where we are beginning to see impressive response rates,” noted Chagpar.
“Patients with HER-2 positive disease now have options with TDM1 for the treatment of residual disease,” she said. In 2019, the FDA expanded the approval for TDM1 to include the adjuvant treatment of patients with HER2-positive early breast cancer who have residual invasive disease after neoadjuvant taxane and trastuzumab-based treatment.
Another important advance, according to Aithal, is the use of CDK4/6 inhibitors along with endocrine therapy in either first-line or second-line treatment for hormone receptor-positive HER2/neu-negative breast cancer, which has “improved progression-free and overall survival in men and both pre- and post-menopausal women, and the use of chemotherapy may be avoided and/or postponed to further lines of therapy.”
Additionally, discoveries presented during SABCS 2019 hold significant promise for the field. “Data was presented using tucatinib, an oral tyrosine kinase inhibitor highly selective for HER2 with minimal inhibition of EGFR (for favorable toxicity) combined with trastuzumab and capecitabine improved median overall survival of 21.9 months versus 17.4 months,” explained Aithal. “Furthermore, this drug resulted in a 46 percent reduction in risk of disease progression or death. [It was also] effective in patients with treated or untreated brain metastasis [and] has been sent for FDA approval.”
Data from the phase II DESTINY-Breast01, which was also presented at SABCS, led to the FDA approval of fam-trastuzumab deruxtecan-nxki for patients with unresectable or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting.
These are just a few of the recent advancements in the breast cancer space that have led to a better understanding of the disease as well as improved patient outcomes.
Promising Directions
With a dedication to ongoing discovery, researchers are exploring a number of promising areas in breast cancer treatment.
One example is imaging. “There are exciting developments with contrast enhanced mammography; although the role this modality will play in the workup of breast cancer patients remains to be seen,” noted Chagpar. “There is a balance to be struck between early diagnosis and overdiagnosis, which continues to be debated.
“More and more, researchers are looking at artificial intelligence and how this could impact all aspects of breast cancer treatment,” she added.
There are a number of challenges and new directions that researchers are currently tackling. For instance, a major challenge in hormone receptor-positive breast cancer is endocrine resistance, according to Aithal. And, she noted, more clinical studies are needed when it comes to targeting androgen receptor signaling pathways in aromatase inhibitor (AI)-resistant breast cancer to overcoming AI resistance.
In triple-negative breast cancer, there are several new treatments that have potential, including checkpoint inhibitors in the neoadjuvant setting. “Triple-negative breast cancer remains the most difficult subgroup of breast cancer,” said Aithal. “Exciting results were noted using checkpoint inhibitors with standard chemotherapy in triple-negative breast cancer in the neoadjuvant setting to improve pathological response rates as in the KEYNOTE-522 phase III trial.”
Future Research
The future of research and discovery in breast cancer includes a more tailored approach to disease management, according to Chagpar. “How can we determine what therapy will be most effective for a particular tumor? How can we reduce toxicity?” These are questions that require further investigation.
“Personalizing treatment options is the key to determining the appropriate plan for each patient, with more biomarker assays and target-specific treatments available,” said Aithal. “More treatments of breast cancers are likely to be driven by biomarkers in order to precisely target therapy, improve efficacy, and reduce side effects.”
While the number of available breast cancer treatments continues to grow, mortality from metastatic breast cancer remains, noted Aithal, who emphasized that more work needs to be done to reduce that rate even further.
“It is an exciting time to be in the field of breast oncology with so many developments to help our patients, and hopefully someday to eradicate this disease,” Aithal told Oncology Times. “I’m looking forward to knowing the benefit of adding CDK4/6 inhibitor to current standard therapy in early-stage ER-positive breast cancer, particularly those at high risk, to prevent recurrence.”
Conference Details
The upcoming Miami Breast Cancer Conference, held March 5-8, will give attendees an opportunity to delve into all aspects of breast cancer treatment and care, including the latest breakthroughs and trends. Sessions cover a plethora of topics such as immunotherapy, gene profiling, physician burnout, and survivorship care.
“The Miami Breast Cancer Conference is always a wonderful place to meet colleagues, and to learn from leading experts about the latest advances in the multidisciplinary care of breast cancer patients,” concluded Chagpar, who is program co-chair of the event. “Often the information shared is relevant, up-to-date, and actionable—so that what you learn at the meeting, you can put into practice the next day in your office.”
Catlin Nalley is a contributing writer.