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Old 01-26-2012, 07:55 AM   #1
Hopeful
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Dr. Clifford Hudis: 2011 Top Stories in Breast Cancer

Interview by L Scott Zoeller. 2012 Jan 24, Clifford Hudis, MD

To mark 2011, we have asked our distinguished OncologySTAT Advisory Board Members to choose their top story of the year. In this interview, Dr. Clifford Hudis discusses his choice for this year in breast cancer.

OncologySTAT: In your view which development in 2011 in breast cancer research could have the most significant impact on oncology?

Dr. Hudis: There were several important developments this year related to different aspects of breast cancer. I think that the demonstration that an aromatase inhibitor, as expected, can be effective primary prevention for women without the disease is important. Now we have three studies that have clearly shown a chemoprevention effect for systemic hormone therapy in patients. This bodes very well for the general population who are worried about breast cancer.

I think the refinement in breast surgery that the ACOSOG study has supported is also critically important. The fact that can we can continue to diminish the impact of surgical therapy on patients without compromising their cure is a very big deal—again, with broad impact potentially on the several hundred thousand people per year with breast cancer.

The third development is in the area of systemic therapy, where we had several important breakthroughs this year with novel targeted therapies, which are both important in the studies where they have been proven, but also have implications far more broadly. The effectiveness of an mTOR inhibitor in the BOLERO-2 trial suggests that this mode of therapy may have broad applicability across many settings of breast cancer. I think that the report at the end of 2011 of the activity of pertuzumab in the CLEOPATRA trial obviously has great promise to further improve the rates of cure for people with early-stage breast cancer. The adjuvant studies for that are already under way.

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

Dr. Hudis: Well, starting again with surgery, we have actually seen already a change in the way in which we view the axillary dissection. Obviously, we have been doing just the sentinel node for years now, but it is now, I think, more and more common for breast cancer physicians to omit an axillary dissection even in the face of a positive sentinel node when the systemic therapy decisions and radiation decisions have already been adequately made. I think that is a very big deal because it has a potential to dramatically decrease the morbidity of treatment for breast cancer.

In terms of systemic therapy, we need to, of course, wait for action at the FDA level for these new targeted therapies like pertuzumab and everolimus to become broadly available; but, I think, based on the data in hand, we will see a change in how people treat patients in the second-line setting when they are getting palliative hormone therapy. I think we will see, as well, fairly rapid uptake of pertuzumab in the first-line setting for metastatic HER2-positive disease.

OncologySTAT: Would you put these developments into historical perspective for the practicing oncologist?

Dr. Hudis: I think that the march away from radical surgery continues—that is, in terms of the axillary dissection. In terms of systemic therapy, of the two advances that I mentioned, the most immediate is pertuzumab. Although the data are early, it looks like the magnitude of the benefit may be similar to the first-step benefit that we got when we started to use trastuzumab for HER2-positive disease.

With regard to everolimus and the mTOR inhibition, I think that story is just a little less clear right now because there are toxicities associated with that therapy, and hormone therapy has been relatively nontoxic treatment for years, which gets somewhat more complicated with the addition of everolimus. The other thing, of course, is we do not have yet any evidence of an impact on survival. In that disease setting, an improvement in overall survival would be really influential, but, again, the evidence is not available.

OncologySTAT: Would you sum up why you chose these developments as the top stories of the year?

Dr. Hudis: I think they are disconnected in one way, but on the other hand, they reflect both old-fashioned mechanics of treatment studies—that is, the axillary dissection—and new-fashioned molecular oncology; but, what they show together is the important contribution of randomized clinical trials because all three of them are the results of just that effort. The fact that so many hundreds of clinicians and thousands of patients around the world are willing to allow their care to be determined by randomization is to be applauded. It is only because of their bravery that we have this data.

Hopeful
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Old 01-26-2012, 11:56 AM   #2
karen z
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Re: Dr. Clifford Hudis: 2011 Top Stories in Breast Cancer

Thanks for post!
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