Since the 6th International Consensus Conference on Advanced Breast Cancer (ABC6), the field of advanced breast cancer treatment has changed a lot with the emergence of new therapeutic agents. At the 7th International Consensus Conference on Advanced Breast Cancer (ABC7), Oncology Frontier invited Dana-Farber Cancer Institute Dr.Eric P.Winer to share with us the changing treatment of breast cancer.
Oncology Frontier :What do you think are the biggest challenges facing breast cancer? How do you think these challenges will affect our treatment and management of breast cancer?
Dr.Eric P.Winer:I think everyone realizes that this is about individuals who had metastatic breast cancer. So having metastatic breast cancer is a bigger challenge than having early stage breast cancer, because it’s an illness that people can live with at times for many, many years. But the vast majority of people ultimately will have metastatic breast cancer threaten their lives. There are still very few women who are cured if they have metastatic breast cancer. So right off, that’s a challenge. I think that our treatments have clearly improved over the years. But we still need better treatments. We need treatments that are more effective. And we need treatments that are better tolerated. Some of our treatments are quite well tolerated. Others tend to have far more in the way of side effects. And so it’s really about optimizing the care we provide to people by both improving on our therapy.
And then I’ll comment on one last issue, which is that I think that for the woman and occasionally man with metastatic breast cancer, that it’s really important to have a close relationship, a trusting relationship, with the team that’s taking care of you, with the oncologist, with the nurses, and others that work with that person. And at the same time, I think it’s a challenge for the clinicians to make sure they understand what the needs are of that patient. And I do believe that we can, as a field, do a better job by continuing to work with our patients and really partner with our patients so that we provide them with not only the best medical care, but the best medical care that’s right for them.
Oncology Frontier :There have been many new developments in advanced breast cancer since ABC6.How do you think the diagnosis and treatment of different molecular types of breast cancer (HR+, HER2+, TNBC) will change after the ABC7?
Dr.Eric P.Winer: it’s a little hard to know how things will change in terms of our consensus statements. Clearly, drugs like trastuzumab deruxtecan, which, of course, was a major advance, particularly for patients with HER2-positive and HER2-low breast cancer, will be something that is a change because those were findings that weren’t available for ABC 6, certainly related to HER2-low breast cancer. But there are other drugs as well. We have new AKT inhibitors like capivasertib. We are in the course of looking at new therapies in triple-negative breast cancer. There are the drugs that seem to be effective in patients with ER-positive breast cancer who have estrogen receptor mutations, so drugs like elacestrant. So I think there have been a number of changes. And the fact that in just two short years we have all these new therapies is a reason to be really optimistic about the future , because from my perspective, every single year we keep having more and more, and the change from one year to the next keeps getting bigger. It’s as if we’re climbing up a set of stairs, and each year we go up a bigger and bigger stair. And ultimately we’ll be at the top, and hopefully that top will mean that no man or, in general, women, will have to lose their life from breast cancer.
Oncology Frontier :ADC drugs offer new treatment options for low HER2 expression. Optimizing the molecular typing of breast cancer also became a hot topic of discussion at this meeting. What do you think about this problem of molecular typing?
Dr.Eric P.Winer: I think that we’re still trying to sort out just where we do molecular subtyping. And in particular where we do genetic sequencing or tumor profiling on the tumor itself. In breast cancer there are an increasing number of situations where this kind of information can be useful. But by no means do I think that every single time we make a treatment change that we have to reassess the molecular profile of the tumor. I think as Dr. Turner said earlier today, that if one is going to obtain, for example, a blood biopsy, looking at circulating tumor DNA, that probably the optimal time to do that, at least in a patient with ER-positive breast cancer, is when that patient has developed disease progression on a CDK4/6 inhibitor. And I think it is important when we’re looking for changes in the tumor to make sure that we get these tests not when someone is responding to therapy, but when their cancer is getting worse on therapy. So this is something we’re still working out, clearly evaluating the genomics of the tumor and, for that matter, of the person. Because, for example, BRCA1 and 2 mutations play a role in treatment decisions as well, germline mutations. These genomic assessments are going to become more and more important over time.
Eric P. Winer
2022-2023 President of the American Society of Clinical Oncology (ASCO)
Professor of Internal Medicine at Harvard Medical School
