Looking Ahead in the Treatment of Breast Cancer

William J. Gradishar, MD, professor of medicine of hematology and oncology, Betsy Bramsen Professor of Breast Oncology, and chief of hematology and oncology in the Department of Medicine at the Feinberg School of Medicine at Northwestern University, discusses the questions ongoing studies are looking to answer in the breast cancer space.

New data has led to an increase of treatment options for patients with breast cancer with guidelines constantly changing to reflect what is newly available. However, Gradishar notes that even with more treatment options, experts are unable to perfectly predict which patients will recur.

In order to gain more insight on this space, the next steps for investigators will include continuing to develop molecular tools, defining the patients who need chemotherapy, and learning who may need extended durations of endocrine therapy.

Transcription:

0:08 | With respect to early-stage breast cancer and how we approach things, our prediction of who is going to recur is still not perfect. We've made an effort over time to develop molecular tools, whether you're talking about MammaPrint or the oncotype test, to define patients who may need chemotherapy, and those that can be treated effectively and safely with anti-hormone therapy alone. They're not absolutely perfect.

0:40 | Similarly, trying to determine who needs extended durations of endocrine therapy. We've had potential tools, the breast cancer index, other things, and that is met with some discordance in the results, so it's not entirely clear. We can always use those tools confidently to determine who can stop therapy or who needs to continue it with respect to endocrine therapy. I think as we go forward, we'll probably be developing better molecular tools to identify a minimal residual disease trying to identify those patients who have subclinical microscopic disease. That may be based on circulating tumor DNA or specific signatures from the primary tumor that we can still identify in the blood. Then we'll have to validate whether or not finding those things and treating them results in a better outcome.

1:43 | The next phase is probably trying to employ some of those molecular tools in a way that helps us further refine what therapies we would give to patients at high risk, but also the same thing, to de-escalate where patients don't need it. Hopefully, we can do that without having to do these 5000 or 7000 patient trials to figure it out.