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  • American Society of Clinical Oncology Meeting -- perspectives from Eric P. Winer, MD (June 2011)

     

    I am headed home from the American Society of Clinical Oncology (ASCO) meeting that was held in Chicago over the past 5 days.  The meeting is huge, with over 25,000 people in attendance.  Although it is an exhausting few days for many of us, it is also a tremendous opportunity to share observations and advances with colleagues from around the world. 

    From a breast cancer perspective, there were no earth shattering findings.  At the same time, there were a number of important presentations that helped us gain a better understanding of breast cancer treatment.  And, our colleagues who care for patients with melanoma and other malignancies rejoiced over major advances.  As a breast cancer doctor, I take great encouragement from these advances, because they arise from an ever more sophisticated understanding of how we can harness our knowledge of cancer biology to improve the treatments for our patients.  Progress in other cancers make it that much more likely we will see major breast cancer advances in the years ahead.  

    So what were the highlights this year? 

    We learned that some patients, particularly those with positive lymph nodes at the time of an axillary lymph node dissection, will benefit from more comprehensive radiation treatments.  Administering radiation to the breast and the surrounding lymph nodes after a lumpectomy, instead of simply giving radiation to the breast, led to fewer recurrences both in the lymph nodes and in other parts of the body.  For many radiation oncologists, this study will change the way they administer radiation to some patients.  

    • For women with HER2+ breast cancer, which accounts for approximately 20 percent of all breast cancer, we heard a number of presentations that will ultimately allow us to use targeted therapy (such as trastuzumab or Herceptin and lapatinib or Tykerb) in combination with one another.  This approach may eventually lead to the elimination of chemotherapy for some patients.  At this time, chemotherapy plus trastuzumab is still the standard treatment to prevent recurrences, but for some women, this standard could change in the years ahead.   
    • Unfortunately, we also learned that the drug iniparib, which showed great promise in a preliminary study (presented 2 years ago at ASCO), did not live up to our expectations.  In the first study, women with triple negative breast cancer experienced better disease control and lived longer when iniparib was added to chemotherapy (carboplatin and gemcitabine) than when chemotherapy was given alone.  The study presented at this year’s meeting was designed to confirm that initial finding.  Instead, it found the combination of iniparib plus chemotherapy was either no better or minimally better than chemotherapy alone.  Work with iniparib will continue, and we may be able to identify a group of patients who truly benefit from this treatment, but additional research will be needed.  Iniparib, which was formerly thought to be a PARP inhibitor, turns out not to be a true PARP inhibitor, but an agent with somewhat similar effects.  There is still tremendous interest in the PARP inhibitors both for women with BRCA1 and BRCA2 mutations, and in combination with chemotherapy for other patients with breast cancer, particularly those with triple negative disease. 
    • In the setting of breast cancer prevention, we learned that the aromatase inhibitor, exemestane (Aromasin), can decrease a postmenopausal woman’s risk of developing breast cancer.   The follow-up from the study was quite short.  Women were only followed for an average of about 3 years.   However, for women at high risk of breast cancer, exemestane is now an option they can consider to lower their risk.  Since exemestance does have side effects, including hot flashes, pains in the joints and sexual difficulties, the decision to take it will have to include a clear estimate of the benefits and the risks for an individual woman.  In my own view, this treatment can be considered for women who are postmenopausal and are at a particularly increased risk of developing breast cancer.  For example, women with lobular carcinoma in situ face an elevated risk of breast cancer and may be ideal candidates for considering an intervention like exemestane. 

    Of course, there were many other important findings, but I have tried to provide the highlights.  We do continue to make progress in the battle against breast cancer, and advances – sometimes small, sometimes large – occur on a monthly basis.   

    As I attended session after session at ASCO, I was also very pleased to see all of the outstanding work Susan G. Komen for the Cure® is supporting.  This work is made possible by all of the thousands of volunteers who work so very hard and raise funds for our Komen grants program.  It is truly a team effort.