This past weekend, Outcomes4me attended the Living Beyond Breast Cancer®’s virtual Conference on Metastatic Breast Cancer. The conference included keynotes on treatment resistance, research advancements, palliative care, and advocacy. We’ve highlighted a few major takeaways from the conference.
Advances in treatment resistance in metastatic breast cancer
Dr. Nancy Lin, Associate Chief Director of Division of Breast Oncology and Director of the Metastatic Breast Cancer Program at Dana Farber Cancer Institute, presented information about treatment resistance in her keynote, “Treatment resistance in metastatic breast cancer”.
There are two forms of treatment resistance:
1) Intrinsic Resistance – when a patient starts new treatment and shows no response.
2) Acquired resistance – when a treatment works for a period of time and then stops working.
Treatment resistance can be resulted by characteristics of the cancer, the drug and the patient. We can overcome resistance by better understanding what exactly is causing resistance and then target it directly, moving on to another target or considering treatment combinations, Dr. Lin, stated and discussed the latest research addressing the problem of treatment resistance in metastatic breast cancer.
Antibody drug conjugates are a relatively new strategy for combating treatment resistance by delivering chemotherapy to the cancer in a more targeted way. This strategy is being studied in all breast cancer subtypes. Two antibody drug conjugates, Trastuzumab deruxtecan (Enhertu®) and Sacituzumab govitecan (Trodelvy®), are currently being evaluated in Phase 3 trials for ER+ breast cancer. Antibody drug conjugates, like Trastuzumab deruxtecan and T-DM1 (Kadcyla®), are currently used in HER2+ breast cancer to combat resistance. A number of clinical trials for HER2+ breast cancer are looking to combine these antibody drug conjugates with Tucatinib (Tukysa®) as a new combination therapy. Triple negative breast cancer (TNBC) patients are also candidates for antibody drug conjugates like Sacituzumab govitecan. In addition to antibody drug conjugates, there are new hormonal therapies being studied in Phase 3 trials like SERDs and CERANs for ER+ breast cancer. In TNBC, researchers are looking to improve immunotherapy response to address resistance. Researchers are also trying to identify specific subgroups of TNBC to develop more precise treatment options to overcome resistance.
Understanding and debunking palliative care myths
Dr. James Tulsky, Chair of the Department of Psychosocial Oncology and Palliative Care at Dana-Farber Cancer Institute and Chief of the Division of Palliative Medicine at Brigham and Women’s Hospital, discussed the benefits of palliative care and challenged palliative care myths during the “Understanding and accessing palliative care” keynote. Dr. Tulksy defines palliative care as “specialized medical care for people with serious illness” which includes relief from symptoms, pain and stress. Palliative care is focused on improving the quality of life for patients and their families.
According to Dr.Tulsky, one of the biggest misconceptions about palliative care is that it is just for end of life. This is not true. Palliative care can be started at any age and at any point in treatment beginning at diagnosis. Palliative care can be provided during active treatment, not just when a patient is no longer receiving cancer therapy—there are no prognosis requirements for receiving palliative care. Palliative care is simply like “an extra layer of support” for patients and their families. Dr. Tulksy presented trials that have shown palliative care can improve quality of life, reduce symptoms like depression, anxiety and pain and even extend life. In a study of patients with metastatic lung cancer, researchers found that after two years 35% of patients receiving early palliative care were still alive compared to 15% of patients who did not receive early palliative care.
If you are interested in palliative, you should discuss your options with your doctor. If palliative care is not available at your cancer center, you can find palliative care through the Get Palliative Care website: https://getpalliativecare.org/howtoget/find-a-palliative-care-team/
Advocating for research
The conference included an overview of the research advocacy landscape, current disparities and the work being done to improve inclusion of diverse participants in research during the “Make your voice heard: advocating for research” panel discussion. The panelists included a number of people representing diverse patient and clinical perspectives. The panelists included: Jamil Rivers, Founder of the Chrysalis Initiative, Maimah Karno, Founder of the Tigerlilly Foundation, Stephanie Waters, leader of the Become project of the Metastatic Breast Cancer Alliance, and Dr. Tatiana Prowell, Associate Professor of Oncology at Johns Hopkins and FDA Scientific Liaison. The panelists stressed that diversity in clinical trials is severely lacking and is a major area for improving disparities in cancer care. As an example, Dr. Prowell showed a staggering statistic that out of 4,000 patients, fewer than 100 African Americans had assessable data in the seven CDK 4/6 inhibitor clinical trials which were used to drive approval for these drugs. Stringent eligibility criteria and participation requirements limit the diversity in clinical trials by excluding patients with comorbidities, patients in rural areas and others. To improve clinical trial design, researchers must broaden eligibility criteria to allow more people to participate in trials and have trials better reflect the overall breast cancer population. Decentralized trials is another method to address disparities. Decentralized trials remove many participation barriers like location so more people can participate in studies.
There are many initiatives working to address diverse patient engagement in clinical trials and throughout the different phases of cancer treatment. The Become Project, initiated by the Metastatic Breast Cancer Alliance, for example, is working on understanding ways to improve African American participation in clinical trials, and is currently surveying patients (https://www.mbcalliance.org/become). In addition, the Chrysalis Foundation has a cancer navigation program to assist patients of all races and stages to knowledgeably engage in their cancer care. As awareness and understanding of disparities in research and barriers to equity grows, it is important that similar important initiatives build support and drive change in research and care processes.
Outcomes4Me is particularly focused on democratizing cancer care and accelerating research through empowering patients to be an active participant in their cancer treatment and care. To ensure more patients are finding the Outcomes4Me app and are being active in their cancer care we are raffling off an Apple Watch for all new users who text MYCARE to 855-575-0047 and log into the app by 4/25.
Lin, Nancy. Treatment resistance in metastatic breast cancer. Presentation, Living Beyond Breast Cancer Conference On Metastatic Breast Cancer. 2021.
Tulsky, James. Understanding and accessing palliative care. Presentation, Living Beyond Breast Cancer Conference On Metastatic Breast Cancer. 2021.
Karmo, Maimah; Prowell, Tatiana; Rivers, Jamil; Walker, Stephanie. Make your voice heard: advocating for research. Presentation, Living Beyond Breast Cancer Conference On Metastatic Breast Cancer. 2021.