Dr. Esteva on the Prevalence of Precision Medicine in Breast Cancer

Francisco J. Esteva, MD, PhD, director, Breast Medical Oncology Program, professor, Department of Medicine, NYU Langone's Perlmutter Cancer Center, discusses the prevalence of precision medicine in breast cancer.

Precision medicine has been part of breast cancer management for decades, starting with targeting the estrogen receptor, Esteva says. More recently, HER2-targeted therapies have transformed the way patients with HER2-positive disease are treated. Now, researchers are moving toward more detailed molecular analysis of a patient’s tumor. For example, in the adjuvant setting, physicians are now utilizing multigene assays like Oncotype DX and MammaPrint, which can help guide a more individualized approach for patients.

Moreover, in the metastatic setting, next-generation sequencing assays are allowing physicians to identify ESR1 mutations, HER2 mutations, and PI3K mutations. In May 2019, the FDA approved the PI3K inhibitor alpelisib (Piqray) for use in combination with fulvestrant as a treatment for postmenopausal women, and men, with hormone receptor-positive, HER2-negative, PIK3CA-mutated, advanced or metastatic breast cancer following progression on or after an endocrine-based regimen. Esteva concludes that it will be interesting to see how this agent makes headway once it is marketed.