Dr Nye on Paradigm Shifts in the Management of HR+ Breast Cancer

Lauren E. Nye, MD, breast medical oncologist, clinical medical director, Breast Cancer Prevention, the University of Kansas Cancer Center, discusses how the expansion of targeted therapies in the evolution of managing metastatic hormone receptor (HR)–-positive breast has shifted management approachescancer throughout the past decade, illustrating a significant shift from traditional treatment paradigms to a more targeted therapeutic approachin this disease space.

Historically, the treatment regimen paradigm in HR-positive breast cancer primarily consisted of endocrine therapy followed by a CDK 4/6 inhibitors and subsequent chemotherapy, Nye begins. The current treatment landscape, however, However, therapeutic approaches in this space havehas expanded beyond CDK 4/6 inhibitors to include a variety of targeted therapies and antibody-drug conjugates (ADCs) prior to the consideration of chemotherapy, she states.

The integration of tumor testing has is accordingly essential forin identifying actionable mutations and tailoring treatment plans, Nye continues. This gShe adds that genetic profiling allows for the identification of patients who would benefit fromenables the deployment of novel new agents that are sspecifically designed to target mutations induced by prior treatmentsrevious treatments. Among these are, mutations in genes such as ESR1, PIK3CA, AKT, and PTEN, and HER2 are pertinent. Notably,. HER2-activating mutations are also a target of interest, Nye details. With the addition ofagents such asado-trastuzumab emtansine (Kadcyla) andfam-trastuzumab deruxtecan-nxki (Enhertu)to the armamentarium, other HER2-targeted ADCs are in development for patients with HR-positive and HER2-positive or HER2-low disease. have become actionable targets with available specific therapeutic options.

Nye emphasizesDespite these advancements, efforts to elucidate the optimal the need to optimize the sequencing of these agents are needed, Nye states. The challenge now lies in refining these strategies to ascertain the most beneficial treatment sequences for individual patients, taking into account the specific genetic alterations present in their tumors. This involves determining the most effective order of therapeutic application to maximize efficacy and minimize adverse effects. The ultimate goal of this approach is to enhance patient outcomes by maximizing efficacy and minimizing adverse effects, Nye emphasizes. using therapies that are not only effective but also bear lesser toxicity.

This paradigm shift reflects a broader trendin oncology towards precision medicine, which promises improved survival rates and quality of life through highly personalized treatment strategies. The challenge now lies in refining these strategies to ascertain the most beneficial treatment sequences for individual patients, taking into account the specific genetic alterations present in their tumors.

Overall, tThe treatment management of metastatic hormone receptor (HR)–-positive breast cancer has undergone profound substantial changes with the advent of targeted therapies and antibody-drug conjugates.ADCs, Nye concludes. The focus of treatment strategies for patients with this disease has shifted from a more generalized approach to an individualized highly specialized one increasingly that considers accounts for patients’ individual tumor characteristics and unique genetic profiles. The ongoing development and integration of these therapies into clinical practice underscore the dynamic nature of oncology and the continuous improvement in therapeutic options available to patients.