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5 questions (and answers!) about the latest breast cancer research

triple-negative brain metastases

We recently hosted an Ask the Expert webinar featuring Dr. Sarah Sammons, a medical oncologist specializing in the care of patients with all stages of breast cancer at Dana-Farber Cancer Institute in Boston and a faculty member of Harvard Medical School. Dr. Sammons discussed the most pressing research highlights presented at the San Antonio Breast Cancer Symposium, an annual event recognized as one of the most important scientific conferences in breast cancer.

See below for a recap of a sample of the questions answered during the live webinar.

Miss the webinar? You can still catch it on-demand within our app here. We’re hosting our next Ask the Expert webinar on February 14th, where we’ll delve into the topic of sexual health and breast cancer. Register here.

The questions and answers below have been edited for grammatical purposes only.

Q: Can the newly FDA approved medication capivasertib be used after progression on PIQRAY? 

A: That’s a good question that we don’t know the answer to. Piqray (or alpelisib) is a PIK3 inhibitor, while capivasertib is an AKT inhibitor. But it targets the same pathway. It’s the AKT pathway. We don’t have any data right now to suggest that it [capivasertib] would have efficacy after [progression]. Depending on a certain situation, an oncologist may try it if they’re trying to avoid chemotherapy, for example. But sadly, we don’t have any data yet to see whether or not it’ll be helpful.

Q: Any updates for triple-negative breast cancer (TNBC)?

A: Things that are going on for triple-negative disease are mostly surrounding antibody drug conjugates. It’s looking like immunotherapy added to antibody drug conjugates is quite promising. And so there are ongoing clinical trials looking at whether or not it’s helpful. We haven’t seen any results of any of those trials yet, and it may be another year or so before we see those.

Q: Are there any new treatments for triple-negative brain metastases?

A: Right now, that space is very heavily dominated by antibody drug conjugates that look quite promising. [See study overviews here.]

Q: My oncologist has suggested a third year of abemaciclib. Can you tell me what the NATALEE trial data suggests in terms of adding a third year of a CDK 4/6 inhibitor?

A: When abemaciclib was given for 2 years, it reduced the recurrence risk. There is no data to say that adding an additional year would be helpful, or, is indicated. Not to mention that only 42% of patients on NATALEE actually completed three years. So we really don’t know the benefit of three years over two.

Q: With ER+, HER2- breast cancer, what is the benefit of MammaPrint and Luminal B status when your Ki-67 is high?   

A: Biomarkers in the early-stage setting are really only used in the HR+, HER2-negative space, and biomarkers called gene expression assays are used in HR+, HER2-negative breast cancer to help us determine if chemotherapy will be successful. And so the Oncotype DX is probably the most common one that’s used. It has 21 different genes within breast cancer. And it gives us the score. And we know that, depending on a certain cut point of the score, that if it’s high, then patients are more likely to benefit from chemotherapy than if it’s low.

MammaPrint is similar, except it just has high risk, low risk. We know that they benefit from chemotherapy: low risk. Lumnial A and Lumnial B are RNA signatures. They don’t help us understand what treatment would be better. They’re interesting for us to know about but really, right now, the only way [oncologists] use them in the early stage-setting is to understand whether or not chemotherapy would be successful, helpful, or recommended.

In the advanced breast cancer setting, biomarkers are much more relevant. In HR+ breast cancer, there are a variety of next-generation sequencing platforms that can be sent to test the mutations within your tumor. Caris is one of them. Foundation Medicine is one of them. Tempus is one of them. At places like Dana-Farber or Memorial Sloan Kettering, there are internal platforms that pathologists run. Any platform that will show the mutational profile of your cancer is going to be helpful because it will help your oncologist understand: Do you have any mutation? Do you have a high-tier molecular burden? Might you benefit from immunotherapy? 

BONUS

Q: Could you please explain the update on the POSITIVE trial that was presented at SABCS?

A: The POSITIVE trial originally reported that patients with hormone receptor (HR)-positive breast cancer could safely pause cancer treatment for up to two years to get pregnant without adverse impacts on their cancer outcomes. In the latest update, researchers shared that patients who paused breast cancer treatment were also able to use assisted reproductive technologies (ART), such as ovarian stimulation for in vitro fertilization (IVF), without increasing their risk of cancer recurrence. Fertility preservation methods, such as freezing eggs before cancer treatment, were found to be safe as well. This information is vital for fertility counseling of young breast cancer patients, offering them the option to conceive without compromising their cancer treatment outcomes, at least in the short term.

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