Below is an excerpt from an on-site interview with Sara A. Hurvitz, MD, director of the Breast Cancer Clinical Research Program at University of California, Los Angeles, Jonsson Comprehensive Cancer Center, highlighting the key takeaways in breast cancer from ASCO 2019.
- "The biggest takeaway is a merging of several papers in the hormone receptor-positive HER2-negative advanced disease. There have been at least 2 phase 3 randomized controlled trials in the metastatic setting for each of the 3 CDK4/6 inhibitors published and presented. All demonstrated similar, very significant improvement in [PFS] with [HR]s well within range of each other. But none demonstrated statistically significant improvement in [OS] (until MONALEESA-7), which showed [OS] benefit in premenopausal women with the use of ribociclib."
- "The bottom line is that when we have a patient present (with metastatic disease), almost regardless of where the disease is located, whether she is symptomatic or not, our go-to should be a CDK4/6 inhibitor plus endocrine therapy. This is important because I think a lot of clinicians still feel that when patients have a heavy disease burden or the liver is involved, there's an impulse to go to the stronger therapy. The presence of toxicity and the strength of the side effects doesn't correspond with effectiveness. And we now have really good data consistently showing that we should be targeting this hormonally and with use of the CDK4/6 inhibitors."
- "In the US, all 3 are available and it’s up to the clinician and patient which to choose. But in much of the world, there is no access to these drugs because of the lack of survival benefits. These data may help provide access globally to this class of drugs, specifically ribociclib."
- "The second take-home from the meeting relating to HER2-positive disease is that we're...moving toward a better understanding of how to predict response to TDM-1 therapies. There was a lot of data presented relating to which patients are most likely to have a complete response to TDM-1-based therapy. These patients really need standard chemotherapy that doesn't select just for the HER2 overexpressing cells. It may come down to the level of HER2 expression in the cancer cells, which, of course, makes a lot of sense."
- "This is a story that is continuing to evolve, but the good thing is that it promises that perhaps in the future we can identify patients who don’t need full-throttle chemotherapy with all the side effects, but who can have a less intense but still highly effective regimen."