Prospects in the Management of Breast Cancer

Transcript:Adam M. Brufsky, MD: I think this has been fabulous. It’s been a great discussion. We reviewed and discussed a lot of information on the latest treatment of advanced breast cancer. And before we end today’s discussion, I’d like to get some final thoughts from each of the participants. So Dr. Hurvitz first. Do you have any final thoughts?

Sara A. Hurvitz, MD: I think it’s a really exciting time because of the areas that were highlighted by my colleagues. The area of immune therapy is going to be very exciting to look at, and I think we’re all hoping we can sort of crack the nut on triple-negative disease. That’s where the chemo A versus BC is really unsatisfying, I think for both patients and clinicians. And we have to get better at distinguishing disease subtypes and developing targeted therapies.

Adam M. Brufsky, MD: Great. Dr. O’Shaughnessy?

Joyce A. O’Shaughnessy, MD: I just want to say that there was one more reason to use denosumab subcutaneously twice a year. Coming out of ASCO.

Adam M. Brufsky, MD: Yes, we didn’t talk about that.

Joyce A. O’Shaughnessy, MD: The Austrian Breast Cancer Study Group that already had shown us in the primary endpoint that there was a substantial reduction in fractures in postmenopausal women on aromatase inhibitors with the denosumab twice a year, 60 mg. And then we saw a disease-free survival benefit at San Antonio this year. So that was quite exciting. It was in the same neighborhood as we had seen in the meta-analysis in postmenopausal women with zoledronic acid which never got FDA approval, unfortunately. So hopefully denosumab will. And it will be another step forward for patients.

Adam M. Brufsky, MD: I agree, and I would say that the vast majority of patients in that ABCSG trial were luminal A, so we may actually have a therapy for luminal A disease that actually has a survival benefit.

Joyce A. O’Shaughnessy, MD: Yes, that’s right: low-risk women.

Adam M. Brufsky, MD: But be that as it may, Dr. Rugo…

Hope S. Rugo, MD: I think the really exciting research direction that we’ve all gone on is the understanding of agents that show some benefit in the metastatic setting that we want to try and identify the subgroup of patients who are most likely to benefit. And it’s both the patients and the disease subtype. One way we can get at that is looking at new agents in the neoadjuvant setting and by looking at the subtype of tumors that are most likely to benefit from those, actually get the drugs to the patients more quickly by testing them in the right patient population, either in the metastatic or the adjuvant setting. So, to me, that’s the most exciting direction, and I think we’re testing all of these drugs in this area and we just need to be smart enough to find the biomarkers that will help us analyze those. And I think these sort of network analyses are the way to go. We need super computers, super minds, and a village of people in trials that are being done all over the world, now together, to try and get to those answers.

Adam M. Brufsky, MD: I agree. That’s really good. And finally, Christy?

Christy A. Russell, MD: Finally, the issue about precision medicine or personalized medicine and community physicians sending tumor specimens off, many archived specimens to commercial groups to find out what mutations there are and having assumptions about therapies that are going to work for them. And some beautiful presentations at San Antonio, one from France and one from a group at MD Anderson, looking at these very detailed programs and trying to understand matching mutations with drugs. And I think that we need to support those efforts much more rather than just the presumption that these commercial companies are giving us information that will benefit our patients at this point. And so it was a great education for me just to see where that science is moving. I think that builds on what you’re saying as well: we need to offer these therapies in a much more precise manner.

Adam M. Brufsky, MD: Right, and hopefully we’ll know that. But we need the super computers, the data gathering, to really go one step beyond just the mutation but actually the pathway, the network sort of thing. No, I agree. Well, this has been a great discussion, guys. Again, on behalf of our panel, thank you all very much for joining us. Thank you.

Transcript Edited for Clarity