Multi-Targeted Therapy Is Extending Non-Chemotherapy Options for MBC

[Hopeful]

Dr. Cliff Hudis: Multi-Targeted Therapy Is Extending Non-Chemotherapy Options in Advanced Breast Cancer

2011 Jan 4, Interview by L Scott Zoeller

Dr. Clifford A. Hudis is Chief, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer, New York, NY.

OncologySTAT:In your view, which development in advanced breast cancer research that occurred in 2010 could have the most impact on oncology?

Dr. Hudis: I think that the big advances in breast cancer research are in targeted therapy, primarily those drugs that are targeting HER2, but also including, obviously, the Poly (ADP-ribose) polymerase (PARP) inhibitors and, potentially, others. This is a somewhat global answer to the question; however, the point I want to make, which is echoed not just in breast cancer but throughout solid tumor oncology, is that it is increasingly clear that many subtypes of individual malignancies are driven by either oncogenes or other narrowly activated targets. These, in turn, can be inhibited in order to treat these malignancies.

The global theme is continued expansion, if not an explosion, in the availability of viable targets for treatment development. This has, I think, the greatest potential impact on all of oncology, not just breast cancer. However, it carries with it a very obvious cost, which is we are going away from, as we have predicted for years we would, the notion of one disease universally consistent across patients.

It is becoming very clear that even people who have similar, if not identical, conventionally defined histologic types of cancer may indeed have molecular biology that is different. This is going to be a huge issue because the rarity of important targets across populations will make drug development increasingly challenging.

OncologySTAT: What specific changes in oncology have you observed or do you foresee as a result of this development?

Dr. Hudis: It is becoming increasingly clear that at least some patients with advanced breast cancer for some period of time may be able to obtain treatment that does not involve conventional cytotoxic chemotherapy. This is an advance in that it represents, at a minimum, a likely quality-of-life improvement, if not an effectiveness improvement, as well.

OncologySTAT: Could you put this development into historical perspective for the practicing oncologist?

Dr. Hudis: In terms of breast cancer, we have had targeted therapy in the form of hormone treatment dating back more than a century, starting with ovarian ablation and suppression. We more recently have had a second viable target, of course—HER2, targeted by trastuzumab. This is revolutionary, although it might not at first seem like it. By targeting these pathways in multiple ways, or by targeting them with more effective drugs, we are essentially able to extend the non-chemotherapy option to patients with disease other than hormone receptor–positive breast cancer.

Now, it is conceivable that we could have several lines of therapy for patients with HER2-positive breast cancers that are chemotherapy sparing, if not chemotherapy avoiding. It is conceivable that we could have even non-chemotherapy–containing regimens for triple-negative breast cancer; albeit, not tomorrow.

OncologySTAT: Would you sum up in a single sentence why you chose this development as the top story of the past year?

Dr. Hudis: We are in the beginning or maybe even middle of a long-awaited transition with functional, practical, and clinically relevant importance that is both redefining breast cancer and its treatment.

Hopeful