Headlines & Helpful Information, Research, Dollars Making A Difference, Leadership
By: Sean Tuffnell
More than 7,500 researchers, clinicians, advocates, health industry professionals and those directly impacted by a breast cancer diagnosis from 90 countries descended on San Antonio, Texas Dec. 4-8 for the 41st annual San Antonio Breast Cancer Symposium (SABCS). The Symposium provides researchers, providers, and patients who are focused on improving breast cancer outcomes as well as anyone who has a special interest in breast cancer the opportunity to hear the latest data from clinical trials and other research projects, discuss advances in screening, diagnosis and treatment, and to connect with colleagues and patient advocates from across the world.
The week-long event rarely disappoints in providing memorable and practice changing moments – and this year was no exception. Here are five key takeaways (two research findings and three observations) from this year’s SABCS.
KATHERINE is practice changing for patients with a risk for metastatic recurrence
One of the most talked about presentations this year was the results of the KATHERINE Phase III clinical trial conducted by Roche, which tested if T-DM1 (Kadcyla®) would be a more effective treatment after surgery (adjuvant treatment) for patients than the standard of care, trastuzumab (Herceptin®).
The drug T-DM1 is the antibody trastuzumab, that targets HER2, attached to a second drug, emtansine (DM1). Trastuzumab recognizes tumor cells with HER2 and blocks it, but with T-DM1, the drug also delivers a chemotherapy drug that helps to kill the tumor cells directly. This ideally limits damage to healthy cells by delivering the chemotherapy directly to the cancer cells with HER2.
According to the researchers, this combination was shown to significantly improve outcomes in early stage, HER2 + patients who still had invasive cancer after neoadjuvant treatment when they went in for surgery. In short, patients with early stage HER2+ breast cancer who used T-DM1 following surgery rather than Herceptin®, which again is the current standard of care, were at a much lower risk of recurrence or death at 3 years after treatment.
What does all of this mean? Patients often receive treatment prior to surgery with the goal of shrinking the tumor. Those who receive treatment prior to surgery and who still have residual disease after that treatment have worse outcomes than those who do not have any obvious disease. These patients are often given treatment after surgery (adjuvant therapy) to reduce risk of their breast cancer coming back, also known as recurrence. In this study, 77 percent of patients with residual disease who were treated with trastuzumab alone did not have their breast cancer return. Yet for those that received T-DM1, that number jumped to 88.3 percent! And incidence of invasive disease improved, decreasing from 22.2 percent of patients to just 12.2 percent, reflecting a 50 percent reduction in the risk of recurrence!
Clinical oncologist after clinical oncologist said this news would absolutely change conversations they were going to have with their patients as soon as they got back home. For example, Komen’s Chief Scientific Advisor, George Sledge, Jr., M.D., Professor of Medicine and Pathology, and Chief of the Division of Oncology in the Department of Medicine at Stanford University, said “The KATHERINE trial will have an immediate clinical impact for patients with aggressive HER2-positive early stage disease. This is a real win for our patients, and further evidence of the importance of randomized controlled trials in defining new standards of care for breast cancer patients.”
After years of promise, effective immunotherapy may be around the corner for breast cancer patients
In past decade many experts thought there was little utility in using the body’s immune system to fight breast cancer. Now understanding how the body’s immune system can play a key role is one of hottest areas of study.
For example, during the recent European Society of Medical Oncology (ESMO) Congress in Munich, Germany, Genentech released findings from their Phase III trial of a cancer immunotherapy combination that shows promise as an effective first-line targeted treatment for some people with metastatic triple negative breast cancer. It showed the combination of Roche’s immunotherapy drug atezolizumab (Tecentriq®) and the chemotherapy drug nab-paclitaxel used as a first-line treatment significantly reduced the risk of the disease worsening and improved survival in people with metastatic (stage IV) triple negative breast cancers that express the Programmed death-ligand 1 (PD-L1) protein -- a protein that has been speculated to play a major role in suppressing the immune system during particular events such as pregnancy, tissue transplants, autoimmune disease and other diseases such hepatitis.
At SABCS, researchers released additional data from the study further showing that this protein can help researchers identify which patients with triple negative breast cancer might benefit from atezolizumab and the chemotherapy drug nab-paclitaxel. These findings suggest that newly diagnosed patients with TNBC should be tested for PD-L1 status.
Straight talk about overtreatment and undertreatment.
A recurring theme of this meeting was over-treatment vs. under-treatment and the importance of striking the right balance for every patient, which means paying close attention to not only tumor characteristics (lymph node status, tumor size and biology), but also other factors such as age, race/ethnicity, socio-economic status, lifestyle, etc., that could influence treatment outcomes.
It used to be that the default position of most doctors and patients was to throw everything and the kitchen sink at the tumors. Now, thanks to the tremendous advances, we are better able to determine who will benefit from what treatment, which has led to a growing movement towards “de-escalation.”
A shift to less chemotherapy is being hailed by some who worry about the toxic side effects. Komen Scientific Advisor Dr. Eric Winer, from Dana-Farber, discussed the need for de-escalation during his Brinker Award Lecture. He noted that while chemo can have “limited” benefits, “toxicity can be formidable” and long-term effects can include leukemia, heart failure, neuropathy, premature menopause and infertility. The challenge is balancing the risks and benefits. For some patients, the risks are substantial, but there is little to no benefit. Thanks to advances in our understanding, for some women we may be able to do less without compromising their outcomes.
At the same time, for many women and men chemotherapy is still very important for their survival. And for others, they are not getting the right treatment or enough treatment. It’s not just one or the other. This is why our investments in research and precision medicine – making treatment decisions on an individual’s unique cancer, rather than just their subtype – are so important.
Increasing discussion of metastatic breast cancer.
As in year’s past, several advocates living with metastatic breast cancer attended the event to learn about the latest advances and to hear about new treatments for metastasis as a growing focus in the breast cancer research community. This year this important population of the breast cancer community was met with an increased level of discussion, both on stage and in halls.
Researchers presented new work from clinical trials focused on brain metastasis. There was a new focus on using genomics (the study of genes and their functions) to more effectively predict recurrence and to better understand how metastatic and primary tumors differ. And there was discussion about how understanding the complexities of metastasis will help find better treatments for patients with metastatic disease.
Komen has increased its focus on metastatic breast cancer and treatment resistance. While more research is needed, SABCS showed signs that thanks to discoveries we’ve made over recent years, this will continue to be an increased area of focus.
Research is having an impact in prolonging lives.
Finally, one of the most poignant and memorable moments for us from the conference did not come from something said on stage. Rather, it was a touching moment between Komen-funded researcher Dr. Shom Goel from Dana Farber and patient advocate Sandi Spivey, who has been living with metastatic breast cancer since 1998.
Sandi has been on a lot of treatments over the course of her 20-year journey with MBC. So many, in fact, that she carries with her a scroll that stretches several feet chronicling them. Studying the scroll, Dr. Goel noted that most of the treatments she has taken did not exist when she was diagnosed with stage IV breast cancer. Staying ahead of the research curve and always knowing what’s next once her current treatment no longer works has been key to prolonging her life. What’s next for Sandi? A treatment that Dr. Goel has been researching with Komen funding.
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