Breast Cancer Preview: Critical Issues Resolved?
Kathy D. Miller, MD
May 22, 2014
Hi. This is Dr. Kathy Miller with Indiana University, here with a preview of what I am looking forward to during the breast cancer sessions at American Society of Clinical Oncology (ASCO®) this year.
If you look at the sessions overall, you will see a field in transition. There are fewer global all-comer clinical trials of cytotoxic chemotherapy, and most of those are not meeting their primary endpoints, so they are not moving the field forward.
You will also see the end of the bevacizumab era. Several large bevacizumab trials are being reported this year, in the adjuvant setting, and some metastatic maintenance trials or neoadjuvant trials, but none of them are likely to revive the use of bevacizumab or even interest in the use of bevacizumab in breast cancer.
You will also see some results asking questions that are very important to our patients with common disease scenarios. For our patients with estrogen receptor-positive disease, if they are still premenopausal as they complete their chemotherapy and are embarking on hormone therapy, are they better off if ovarian suppression or oophorectomy is a component of their treatment? Those are questions to which we have been looking for answers for a decade or more. The TEXT and SOFT trials
[1] will be reported in aggregate at this year's plenary session and should finally give us a concrete answer to that important question.
Also in the hormone therapy area, for our young patients interested in preserving fertility, and helping to avoid menopausal symptoms -- particularly in patients whose tumors are estrogen-negative, where blocking estrogen is not going to be a component of their therapy -- can we effectively treat their breast cancer with chemotherapy and yet preserve ovarian function and avoid menopause? The POEMS (Prevention Of Early Menopausal Symptoms) trial
[2] is going to be reported this year at ASCO.
And for our patients with HER2-positive disease, we have seen improvements in HER2 therapy with dual HER2-targeting in the metastatic setting and in the neoadjuvant setting, but the first large dual HER2-positive targeted trial in the adjuvant setting
[3] (in this case, the outcomes trial) will also be presented this year at the plenary session.
Those are the trials that are really going to move things forward. It is a remarkable transition, and you can see that being borne out in this year's ASCO session.
I hope to see you there. If you see me, please stop and say hello. Give me your thoughts on future topics, and I hope you have a great meeting.
http://www.medscape.com/viewarticle/825412