Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

You've all likely seen this information but I though it was worth posting and the author is apparently very thorough.

A CHRISTMAS / HANUKKAH / HOLIDAY GIFT BASKET FROM SABCS 2017

The Winter holidays - rather quietly - brought some extraordinary holiday Cheer and Hope in the way of powerful frontier-edge advances in the treatment of all forms of breast cancer, for ER+ disease, and for HER2+ disease, and for TNBC, and for BRCA-positive breast cancers. Below I give my choices of the best of these, with some critical - and optimistic - commentary of my own.

Breakthroughs in Endocrine Therapy
I have already written about the breakthrough results in endocrine therapy (for ER+ disease) stemming from the FDA approval of the selective CDK4/6 abemaciclib (Verzenio): exceptional survival outcomes even in later stage metastatic disease in heavily pretreated patients, outcomes higher than any other agent used in breast cancer to date; high rates of response; durable survival benefits; its combination possibilities with aromatase inhibitors and fulvestrant and PD-1/PD-L1 checkpoint inhibitors among others. Al this following the impressive efficacy of two other FDA-approved CDK4/6 inhibitors, palbociclib (Ibrance) and ribociclib (Kisqali).

SABCS 2017 now brings us further promising benefits of combining abemaciclib (Verzenio) with the checkpoint inhibitor pembrolizumab (Keytruda), where the JPCE trial found benefit in pretreated ER+ disease without adding any additional toxicity. In addition, the phase II neoMONARCH trial found neoadjuvant abemaciclib (Verzenio) plus anastrozole active in early breast cancer, dropping the rate of proliferation (Ki-67) to below 2.7%.

In addition, the MONALEESA-7 trial showed that ribociclib (Kisqali) improves PFS by 10.8 Months in ER+ pre- and peri-menopausal patients with advanced breast cancer: the median PFS was 23.8 months for women who received ribociclib (Kisqali) combined with either tamoxifen or a nonsteroidal aromatase inhibitor (AI) plus goserelin (Zoladex), compared with 13.0 months for those who received standard endocrine therapy, highly significant results for the challenging group of younger-aged breast cancer patients.

Breakthroughs in HER2 Therapy
We also saw some significant advances in HER2-positive disease. The Phase IB/II PANACEA trial found that the combination of the checkpoint inhibitor pembrolizumab (Keytruda) plus trastuzumab (Herceptin) can achieve an impressive disease control rate (24%) in trastuzumab-resistant, PD-L1–positive, HER2+ breast cancer patients, potentially adding another weapon in our arsenal of effective anti-HER2 therapies.

In addition a new formulation of trastuzumab (Herceptin), namely trastuzumab deruxtecanwhich is a highly potent antibody conjugate (like T-DM1 (Kadcyla)) was highly active in heavily pretreated patients HER2+ metastatic breast cancer patients, with a exceptional durable overall response rate (ORR) of 61.4%, extremely impressive given that this was in patients who had already moved through some of the most potent HER2-targeted therapies including trastuzumab (Herceptin) itself, and T-DM1 (Kadcyla), and pertuzumab (Perjeta), and also impressive was a disease control rate (which includes stable disease) of between 84.2% up to 100%!

With an FDA Breakthrough Therapy Designation, I expect to see regulatory approval quickly, adding an exceptional exciting and powerful new agent to anti-HER2 therapies for advanced disease.

Breakthroughs in TNBC Therapy
In the challenging TNBC arena, SABCS 2017 brought us what I consider to be four breakthrough advances.
One phase 1 study of TNBC patients who were already heavily pretreated found that monotherapy with an antibody drug conjugate (ADC) biological agent, ladiratuzumab vedotin (SGN-LIV1A), showed encouraging antitumor activity in a with heavily pretreated TNBC, with a 58.3% disease control rate (including stable disease). This brings a targeted biological agent into the TNBC therapeutic context, rather than just chemotherapies.

In addition, the ENHANCE1/KEYNOTE-150 Phase IB/II trial found the checkpoint inhibitor pembrolizumab (Keytruda) plus eribulin (Halaven) delivered impressive efficacy in patients with metastatic TNBC, with disease control rate of 36.8% in this highly challenging population.

Still another immunotherapeutic agent, sacituzumab govitecan / IMMU-132 (another antibody-drug conjugate (ADC) achieved an objective response rate (ORR) of 34% in patients with heavily pretreated metastatic TNBC, and better survival outcomes than available conventional chemotherapies in this context.

Finally, the CALGB 40502/NCCTG N063H trial found that third-generation taxane, nab-paclitaxel (Abraxane) - one of my favorite drugs for metastatic breast cancer - shows promising improvements in both overall survival (OS) and progression-free survival (PFS) compared to standard paclitaxel (Taxol) for patients with metastatic TNBC, with a 26% reduction in the risk of death.

Breakthroughs in BRCA+ Therapy,
Two advances in PARP inhibitors continue to expand our regimen stockpile against BRCA-mutated breast cancer: the Phase III EMBRACA Trial found that PARP inhibitor talazoparibimproved PFS in BRCA-positive patients, impressively reducing the risk of disease progression or death by 46% versus chemotherapy. And the MEDIOLA Trial showed that a unique combination of the PARP inhibitor olaparib (Lynparza) plus the immunotherapeutic checkpoint inhibitor durvalumab (Imfinzi) elicits a disease control rate of 80% (!) for pretreated patients with germline BRCA-mutated, HER2-negative metastatic disease. These are truly breakthrough findings in the treatment of BRCA+ metastatic disease.

HEALTH | HAPPINESS | HOPE
TO ALL!

Constantine Kaniklidis
Director, Medical Research, No Surrender Breast Cancer Foundation (NSBCF)
Oncology Reviewer, Current Oncology [journal]
Society for Integrative Oncology (SIO)
Member, European Association for Cancer Research (EACR)

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

Thanks Cathy - a great article, summarising the latest advances. Any way you can provide a direct link? I would love to share with my Aussie groups, but am a bit of a Luddite.
Best wishes..... Pam

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

Pam; I'm just looking and in the meantime found another article you might enjoy.

http://www.healthcareitnews.com/news...ncer-treatment

best wishes back at you,

Cathy

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

Pam;

I've found the article and it was posted in full by a lady on the community.breastcancer.org site so I don't have a link. I think though that I must track down this guys so I can follow all of his articles.

Sorry about this,

Cathy

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

HAPPY HAPPY!!!

Bones scan is clear. No bone mets. I'm going to ask about going on actonel as I think that protects against getting them. See the onc on the 24th.

ASCO begins June 1st!! Here's a link to peruse the abstracts.
http://abstracts.asco.org/214S/search.php?zoom_que...

Best wishes all,

Cathy

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

Wonderful news!


So happy for you!


all the best
caya

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

So happy for you ! Great news!!!

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

Cathy,

Great and I loved seeing your "HAPPY HAPPY!!!"

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

Great news!

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

YAY!!! Happy Happy with you!!

Carol Ann

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

Whoop! Whoop!!!! That is great news!

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

Thank you so much everyone!!! I was so surprised and happy. Now I just have to wait to hear about the ovarian cancer (hope my ca125 drops over the next couple of months) and how the Ibrance and Letrozole is working....in 2 1/2 months. Yuk waiting.

Cathy

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

OMG I just got some fabulous news!! My CA125 was 292 in early March, 359 in April and today it had DROPPED to 62. This means (so far as we know) that it was high due to the bc mets in my lung lining and secondly that the treatment I have been on for 3 weeks is working. Normally the CA125 is used to identify a recurrence of ovarian cancer (my biggest worry) but sometimes if your bc recurrence is in the lining of an organ it rises....as it appears to have done in my case. So now I have hope again as treating ovarian cancer and bc at the same time would be very difficult as the treatments counteract each other. Wow, I am so happy today. Still stage 4 but happy none the less.

God bless you all and I hope you all have some good news to celebrate. I bought ice cream. hahaha

Cathy

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

YAY fabulous news!!! Ice cream AND cake, I say!! :)


Carol Ann

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

Great news! Enjoy that ice cream!

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

So happy for you Cathy and celebrating with you!

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

Carol Ann, Donna and Tricia;

Thank you so much for joining me in celebrating this great news. My oncologist is also looking into adding biophosphonates to my regime as a deterrent to future potential bone mets and for the effects of Letrozole. Plus I got a prescription for Bactroban ointment which others having my treatments run under their noses and a little inside to protect against infections if flying, shopping malls, etc. It would be good for chemo patients too I would think as Ibrance is considered by some as an oral chemo.

I will be watching the Asco news in the next couple of weeks for news but keep my treatments in mind if you ever need them. I'm finding the side effects minimal.

God bless you,
Cathy

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

And biophosphanates seem to also have a slight chemo affect too. Very happy about all your news over the last week's. Just wasn't online to say yay

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

Doing the happy dance for ya, Cathy! Terrific news!

Re: almost 14 years NED breast cancer and apparently it's back in my lungs
 

Becky and Laurel;

Thanks so much. Apparently a similar situation with the rising CA125 was featured on Greys Anatomy a few weeks ago. I wish I'd seen it haha. I do hate being the "weird" patient though.

Cathy