Dr Kalinsky on Remaining Treatment Questions in Breast Cancer

Kevin Kalinsky, MD, MS, associate professor, the Department of Hematology and Medical Oncology, Emory University School of Medicine, director, the Glenn Family Breast Center, Breast Medical Oncology, Louisa and Rand Glenn Family Chair in Breast Cancer Research, Winship Cancer Institute of Emory University, discusses key takeaways from the 2023 Bridging the Gaps in Breast Cancer meeting, highlighting questions that continue to persist in the treatment of breast cancer.

Kevin Kalinsky, MD, MS, associate professor, the Department of Hematology and Medical Oncology, Emory University School of Medicine, director, the Glenn Family Breast Center, Breast Medical Oncology, Louisa and Rand Glenn Family Chair in Breast Cancer Research, Winship Cancer Institute of Emory University, discusses key takeaways from the 2023 Bridging the Gaps in Breast Cancer meeting, highlighting questions that continue to persist in the treatment of breast cancer.

The Bridging the Gaps meeting sparked conversations covering a range of concepts, delving into the current landscape of estrogen-driven breast cancers and HER2-positive breast cancers, Kalinsky begins. Discussions touched upon considerations for patients choosing to opt in or out of specific therapies, as well as the progress in developing various novel agents, he states. Notably, the conversation explored the realm of antibody-drug conjugates (ADCs). Although the discussions yielded answers to some questions, it remains evident that as more advances are made across the breast cancer treatment paradigm, the more questions emerge, Kalinsky says.

An observation from the ongoing conversation surrounds the rapid pace of developments and the need to keep pace with the evolving understanding of this landscape, he expands. Despite gaining a clearer comprehension of certain phenomena, the approval of new drugs can introduce distinct resistance mechanisms that shape future therapeutic approaches. Much of the discussions revolved around grappling with these quandaries in patient care, Kalinsky emphasizes, adding that time was dedicated to exploring the development of novel drugs. Over the past few years, a discernible shift has occurred in the approach to treating patients within certain subtypes of breast cancer, such as estrogen-driven, HER2-low, or triple-negative disease, Kalinsky states. A central focus has been on defining the criteria for adjusting treatment paradigms, such as whether the bar for such adjustments relies on achieving an improvement in progression-free survival vs overall survival, he explains.

The intricacies of resistance mechanisms, especially concerning ADCs, have been a focal point of research, Kalinsky continues, adding that discussions touched upon whether resistance stems from the drug's target or its payload. Previous data in genitourinary cancers have suggested that combining ADCs may represent an effective strategy. Although numerous questions remain, the ongoing dialogue is an encouraging sign for patients, Kalinsky concludes.