Pathology, Oncology Collaboration in Breast Cancer

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The optimal treatment of patients with metastatic breast cancer is reliant on collaboration between medical oncologists and pathologists, explains Francisco J. Esteva, MD, PhD. This collaboration, along with other specialists, is imperative to ensure that appropriate tissue biopsies are collected and the necessary tests are performed.

The collaboration between medical oncology and pathology will be especially important as the field of genetic testing in breast cancer continues to become more complicated. The future of genetic testing will include next-generation sequencing (NGS) strategies, which sequences the entire tumor to identify which mutations are present.

At this time, the costs associated with NGS are reasonable and the turnaround time is rapid; however, the clinical relevance of the data is unknown. Esteva states that it is still too early to know how oncologists can use this genetic information, as many mutations identified may not be actionable.

To explore this further, the National Cancer Institute is launching a study called the “NCI Match,” which includes more than 20 arms. Each arm of the study is similar to a standalone phase II clinical trial (with two arms of treatment). Patients with any type of metastatic disease will have a tumor biopsied and sequenced, then the study will assess how responsive the patient is to a therapy selected to target a particular mutation. The study hopes to discovered targeted therapies for an array of mutations.