Which Studies Will be Practice Changing in Metastatic Breast Cancer?

In In The News by Barbara Jacoby

By: Greg Lau

From: medpagetoday.com

Promising findings from various clinical trials at the San Antonio Breast Cancer Symposiumopens in a new tab or window (SABCS) have the metastatic breast cancer research community excited about the future of treatment.

In this exclusive MedPage Today video, Jason Aboudi Mouabbi, MD, assistant professor in the Department of Breast Medical Oncology at the University of Texas MD Anderson Cancer Center in Houston, discusses a few of the studies he believes will change practice in metastatic breast cancer.

he following is a transcript of his remarks:

At the San Antonio Breast Cancer Symposium, we had the privilege to see a lot of exciting studies being presented for the first time, and they’re definitely going to shape the future of metastatic breast cancer, the way we treat it, the way we look at it, and it’s also going to give us more ideas to further investigate newer stuff in the future.

What is practice changing? I have a few of them that come to mind. So the first one is a study called the CAPItello studyopens in a new tab or window, which looked at an AKT inhibitor called capivasertib. And we found very interesting results from that study where patients that received that in combination with endocrine therapy, after having progress on first-line therapy, they doubled the progression-free survival and there was a trend toward improvement of overall survival. I think this is a very interesting and exciting study, and hopefully it’ll get the approval and definitely it’s an area of unmet need, and it’s going to expand our treatment options for the patient in that population.

Another study that’s really exciting, also it’s another oral SERD, that was also presented at this San Antonio [meeting], is from the SERENA-2 studyopens in a new tab or window that showed that when they compare this oral SERD to the injectable SERD called fulvestrant, that it improved outcome, especially in the patient with ESR1 mutation, which is also an area of unmet need.

Other studies that came to this meeting with some updates such as the TROPiCS2opens in a new tab or window, we got some update about estuzimab that regardless of the Trop2 expression, everybody was benefiting from this therapy, which is excellent news and an excellent thing to know.

But also there was a lot of smaller studies that can shape up the future. And one of those studies that come to mind is a TRIO-US B-12 study, is called also the TALENT studyopens in a new tab or window, that looks at neoadjuvant trastuzumab deruxtecan plus or minus anastrozole. And we found that this drug is active in the neoadjuvant setting with a decent response rate and decent outcomes after surgery. So I’m very excited to see this drug compared to chemotherapy in the future.

Also, one more study that also added more information to us is the RIGHT Choice studyopens in a new tab or window. And this is for patients in the first-time metastatic setting with what quote-unquote we call aggressive disease. These are the patients where they usually, we think about them, they’re having visceral crisis, they’re having organs that might fail if we don’t act fast on them. Historically, those patients we used to always give them chemotherapy before any endocrine therapy. But here the study was very adventurous and randomized patients to either receive chemotherapy or to receive endocrine therapy over CD4/6 inhibitor. And we found that actually giving endocrine therapy over CD4/6 inhibitor in this aggressive subtype did better than chemotherapy. So this is very exciting. This is something we kind of knew it was going to happen, but nobody really did the study before, but now we have some evidence that it does work.