Dr Jhaveri on Unanswered Questions in Breast Cancer Care

Komal Jhaveri, MD, FACP, section head, Endocrine Therapy Research Program, clinical director, Early Drug Development Service, Patricia and James Cayne Chair for Junior Faculty, Memorial Sloan Kettering Cancer Center, discusses unmet needs for patients with breast cancer, as well as ways to address these needs through discussion and collaboration. Jhaveri was co-chair of the 2023 Bridging the Gaps in Breast Cancer meeting.

Several agents have recently gained FDA approval in the breast cancer space, including novel targeted therapies, such as elacestrant (Orserdu) for patients with ESR1-positive tumors; PI3K inhibitors; and AKT inhibitors. One novel regimen pending regulatory approval for patients with advanced hormone receptor (HR)–positive breast cancer is the AKT inhibitor capivasertib in combination with the selective estrogen receptor degrader fulvestrant (Faslodex). This combination received priority review from the FDA in June 2023.

Furthermore, several antibody-drug conjugates (ADCs) are approved for patients with breast cancer. Data from the phase 3 TROPION-Breast01 trial (NCT05104866), which were presented at the 2023 ESMO Congress, also demonstrated the clinical activity of the emerging ADC datopotamab deruxtecan (DS-1062a) in patients with HR-positive, HER2-negative metastatic breast cancer.

Although these new data and novel agents are expanding the breast cancer treatment paradigm, several questions remain regarding their use in clinical practice, Jhaveri says. For instance, the optimal sequencing of therapy for patients with estrogen receptor–positive breast cancer after progression on a CDK4/6 inhibitor is unknown, Jhaveri explains. Furthermore, the presence of ESR1 or PIK3CA mutations may influence these sequencing decisions, and the role of elacestrant vs a PI3K inhibitor in these patient populations is unclear, Jhaveri notes.

Similar questions arise in the management of HER2-positive breast cancer, according to Jhaveri. For example, patients with HER2-positive disease and certain risk factors may benefit from increased doses of immunotherapy or targeted therapy, Jhaveri says.

Overall, the goal of the Bridging the Gaps in Breast Cancer meeting is to facilitate conversations between breast cancer experts regarding controversies arising from current clinical data, Jhaveri emphasizes. Identifying these areas of ongoing debate is the first step toward addressing the needs of patients with breast cancer and improving outcomes in this disease space, Jhaveri concludes.

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