Dr. Rugo on 20-Year Span of Breast Cancer Advancements

Hope S. Rugo, MD, director, Breast Oncology and Clinical Trials Education, University of California San Francisco Comprehensive Cancer Center, discusses the therapeutic advancements in the breast cancer space in the past 20 years.

Breast cancer has gone through an entire revolution, Rugo explains; in this timer period, aromatase inhibitors first arrived in the early-stage setting and HER2-directed therapy with trastuzumab (Herceptin) also became available. Trastuzumab has improved outcomes for patients with early-stage breast cancer and has also improved survival in the metastatic setting. Other agents that have moved through the pipeline have also demonstrated survival benefits, she says.

In the hormone receptor-positive setting, treatment additions have included aromatase inhibitors and fulvestrant (Faslodex), as well as better dosing and scheduling of fulvestrant. There have also been targeted agents with the mTOR inhibitor everolimus (Afinitor), CDK4/6 inhibitors, and the alpha-specific PI3K inhibitor alpelisib.

Recently, there has been an explosion in understanding immunotherapy in triple-negative breast cancer (TNBC), including the recent approval of the frontline combination of atezolizumab (Tecentriq) plus nab-paclitaxel (Abraxane) for patients with unresectable locally advanced or metastatic PD-L1—positive TNBC.

Additionally, it has been concluded that patients who achieve a pathologic complete response from neoadjuvant chemotherapy have a likelihood of being cured of their disease, Rugo says, and for those who do not achieve a pCR, outcomes can also be altered with a plethora of other agents.

There have also been advances regarding supportive care, including dose-dense therapy, pegfilgrastim (Neulasta), scalp cooling, and the prevention of mouth sores with everolimus and of hot flashes.

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