news from ASCO-- some joyous, some a downer--may set things back a bit

[Lani]

The last few ASCOs and San Antonios I have been hearing about the "overabundance of riches" of numbers of drugs approved and available for her2+ breast cancer How could there EVER be too many!

YESTERDAY, , there was a talk by Edith Perez on how helpful herceptin is in T1abc No patients-- hardly anyone treated with chemo and herceptin recurred.(which is why it took so long to come up with that result)

Today, Martine Piccart reported the first findings from the ALTO study. Neo ALTO had previously been reported (I SEEM TO THINK THAT WAS @ SABCS) and had fabulous results regarding how many more pCRs there were with neoadjuvant dual her2 blockade.

Today's report was of adding lapatinib to herceptin ADJUVANTLY, not neoadjuvantly, and there was no real statistically significant improvement found by adding lapatinib to herceptin adjuvantly, but lots of side effects (mostly rash and diarrhea as many of you here have noted)

The reason today was a downer is that George Sledge followed Dr. Piccart on the podium and presented the summary/editorial about what it all meant and then later on there was further discussion in a
postplenary"session. On both occasions, he and others generalized (perhaps overgeneralized) that this was likely going to be the early "end" of the FDA's new policy of approving new drugs based on pCR results in neoadjuvant trials(as occured with pertuzumab), without requiring the thousands of patients and tens of years required to produce a successful adjuvant trial.

Already they were talking of giving up on pushing dual her2blockade into the adjuvant arena eg, pertuzumab+ herceptin, and although Martine Piccart said instead of trying to find new and better antiher2 drugs and combinations, perhpas they should be turning their efforts to trying to discover if there is a subset of patients who do not need chemo in addition to her2 therapy.



It has sounded to me in the last year and a half or so as if the clinical researchers were no longer as "excited" by the prospect of "curing" her2+ bc or at least turning it into a chronic treatable disease and would be turning their interest and efforts elsewhere. While I wish they could get as remarkable results with triple negative breast cancer, we are still losing way too many to this disease which needs more drugs, more combos and better biomarkers, pathway elucidation, and understanding of its "Achilles heel" as well needing to be further subdivided into many more subsubtypes in order to be divided and conquered.

My sense is that their earlier resolve to do better may be being tempered by their fear the cost of treating with two or more exhorbitantly expensive drugs and what it will mean for healthcare finances.**

Perhaps it will turn out that immune therapies like adoptive Tcell therapy will turn out to be more effective (although probably not cheaper) than multiple targeted agents. I just hate to see people turn so negative so quickly, when
the need for better solutions is so great.

**All the more reason to start testing for disseminated tumor cells (via bone marrow testing) -- perhaps treating only those with dtcs with combination therapy or other expensive regimens will save both money, lives, likelihood of producing second cancers, cognitive deficits, early aging from nontargeted agents etc

I, myself, interpreted Dr. Piccart's paper differently--that it showed that herceptin's action through ADCC (the immune system) was far more important and difficult to
become resistant to than just her2 receptor blockade/inhibiting of the tyrosine kinase (as lapatinib did) and that enhancing the ADCC or working via interruption of cell cycle (as Y. Yarden recommends) would be more efficacious.

I was saddened by the news on Barb tonight and remembered that after hearing this paper and the comments it spawned, I wanted tp give a peptalk to the young researchers standing by their posters so they would come up with the "latest and greatest" However there was no poster session this afternoon. In fact there seems to be more drug company "real estate" in the Chicago McCormick Place convention center and less for posters at this year's ASCO (as compared to previous meetings) with less poster presenters standing by their posters, as well.

It is a still a fabulous conference and there were lots of very exciting talks on many different cancers---just not particularly her2+ bc.




There were a lot of remarkable things to report on (and I hope to when I am more rested), but her2 was not the star it was at SABCs or previous ASCOs I am sorry to report. Still another day and a half until the meeting ends, though

Off to get some shut-eye!