BREAST CANCER

The most interesting developments and approvals in breast cancer treatment in the last year and expectations regarding data that will be presented on at the upcoming 2020 San Antonio Breast Cancer Symposium.

Comparing the efficacy of selective HER2 kinase inhibitors in HER2-positive metastatic breast cancer, it was shown that tucatinib may have been approved in the second-line setting due to it's unique impact on the central nervous system. Another HER2 inhibitor, trastuzumab deruxtecan has demonstrated promise in a phase 2 study and is now being confirmed in a phase 3 study.

In an interview with Targeted Oncology during the 2020 Association for Molecular Pathology Annual Meeting, Ozge Ceyhan-Birsoy, PhD, discussed genetic testing methods for patients with hereditary predisposition and the molecular research underway at MSKCC to improve testing in this patient population.

Patients who received palbociclib and fulvestrant before chemotherapy for metastatic breast cancer had greater clinical benefit versus patients who received placebo and fulvestrant, according to an exploratory subgroup analysis of the phase 3 PALOMA-3 trial.

The FDA granted approval to pembrolizumab in combination with chemotherapy as treatment of patients with locally recurrent unresectable or metastatic triple-negative breast cancer whose tumors express PD-L1.

Updated data reported from a phase 3 trial show that patients with HER2- positive early breast cancer had better rates of overall survival after experiencing a pathologic complete response on HER2-targeted therapy, and these responses were observed most often in those with hormone receptor–negative status.

A phase 3 study was initiated for a head-to-head comparison of trastuzumab deruxtecan versus T-DM1 as adjuvant treatment of a subset of patients with HER2-positive early breast cancer.

As a greater understanding of triple-negative breast cancer heterogeneity develops over time, combinations of PD-1/PD-L1 plus PARP inhibitors, androgen receptor targeted agents, and PI3K/AKT/mTOR pathway inhibitors are undergoing evaluation by investigators in the field.

Recent acceleration in the introduction of new regimens for the treatment of estrogen receptor–positive breast cancer has led to significant survival enhancement, but questions remain regarding how patients should be stratified following disease progression with these therapies.

In a presentation at the 2020 Lynn Sage Breast Cancer Symposium, Virginia G. Kaklamani, MD, DSc, reviewed the current genomic tools in the triple negative breast cancer landscape that predict response to targeted treatments.

A number of targeted agents have been approved in the setting of metastatic breast cancer, which has allowed for more personalized treatment approaches and underscores the importance of genomic testing.

Breast cancer data reported during the 2020 European Society Medical Oncology Virtual Congress revealed major advances in the treatment paradigm. The agents included in these trials challenged that standard-of-care.

Palbociclib in combination with standard endocrine therapy did not improve invasive disease-free survival in patients with hormone receptor-positive, HER2-negative early breast cancer who have residual invasive disease after completing neoadjuvant chemotherapy, missing the primary end point of the phase 3 PENELOPE-B trial.

The FDA issued a draft guidance that encourages the inclusion of premenopausal women with breast cancer in clinical trials, which will in order tohelp researchers determine the efficacy of a hormonal drug or biological products for this population along with others.

In an interview with Targeted Oncology, Daniel A. Vorobiof, MD, discussed the evolution of the breast cancer treatment landscape and the emerging role of genomic testing in this space during Breast Cancer Awareness Month.

A Fast Track designation was granted by the FDA to eganelisib in combination with an immune checkpoint inhibitor and chemotherapy for the first-line treatment of patients with inoperable locally advanced or metastatic triple-negative breast cancer.

Race, socioeconomic status, and care barriers are factors that affect the timing of treatment and treatment duration throughout the care continuum according to a recent study.

Patients with endocrine-sensitive hormone receptor–positive, HER2-negative metastatic breast cancer, treated with Frontline fulvestrant in combination with palbociclib experienced improvement in progression-free survival at 1 year compared with fulvestrant and placebo alone, achieving the primary end point of the phase 2 FLIPPER trial.

Findings from the phase 3 monarchE trial reported at the ESMO Virtual Congress 2020 showed that the risk of invasive disease with ​abemaciclib plus endocrine therapy was significantly reduced versus endocrine therapy alone in patients with high-risk early hormone receptor-positive, HER2-negative breast cancer.

The pathologic complete responses were significantly improved with neoadjuvant atezolizumab in combination with nab-paclitaxel plus doxorubicin and cyclophosphamide compared with placebo and chemotherapyin patients with stage 2 or stage 3 triple-negative breast cancer.

Patients with HR-positive, HER2-negative breast cancer experienced significant benefit when treated with neoadjuvant chemotherapy with intense dose-dense epirubicin, paclitaxel, and cyclophosphamide.

Abemaciclib in combination with tamoxifen led to an improvement in overall survival compared with abemaciclib alone in patients with hormone receptor–positive, HER2-negative metastatic breast cancer. Notably, the benefit of the combination was observed across all subgroups in the study, according to findings from the final OS analysis of the nextMONARCH trial presented during the 2020 European Society of Medical Oncology Virtual Congress.

Postmenopausal patients with PIK3CA-mutant, hormone receptor–positive, HER2-negative advanced breast cancer in the SOLAR-1 trial experienced prolonged overall survival with alpelisib and fulvestrant even though the study did not cross the prespecified O’Brien-Fleming efficacy boundary (P ≤ .0161), according to research presented at the 2020 ESMO Virtual Congress.

The combination of atezolizumab, carboplatin, and nab-paclitaxel increased pathological complete response by 10% or more in “immune-rich” patients with high-risk and locally advanced triple-negative breast cancer, as well as turned PD-L1 negative tumors positive most patients treated with immunotherapy, according to the phase 3 NeoTRIPaPDL1 trial data presented at the 2020 ESMO Virtual Congress.

An improvement in progression-free survival and objective response rate was not observed with the addition of ipatasertib to paclitaxel in patients with PIK3CA/AKT1/PTEN-altered hormone receptor–positive, HER2-negative advanced breast cancer.