What Was the Exciting News Out of SABCS?

What was the big news out of SABCS? Nothing monumentally practice-changing yet, but lots of exciting news on the horizon. 

"I don't think next Monday I'm going to practice differently. But I think over this year there's a lot of changes," says Dr. Naoto T. Ueno, an attendee. 

Naoto T. Ueno, MD, PhD is the Section Chief of Translational Breast Cancer Research in the Department of Breast Medical Oncology at The University of Texas MD Anderson Cancer Center, as well as the Executive Director at the Morgan Welch Inflammatory Breast Cancer Research Program and Clinic.

Dr. Ueno thought the most excitement came from the new treatment potential for HER2 metastatic disease, specifically two drug treatments, the first being a combination: tucatinib and trastuzumab.

"Adding [tucatinib to trastuzumab] improves the outcome of the patient in terms of progression-free survival, but in the subset of patients who had brain metastasis, it was effective. (Which is a first to be confirmed, that it helps people who have had two positive brain metastasis.) So I think that's fantastic news," says Dr. Ueno. "I'm speculating that this drug will get FDA approved, and I think it will be a practice-changing if it does get approved."

The other drug is DSA2O1A, an HRT2 antibody conjugate with promising phase two data. The drug is now approved by the FDA on 12/20/19.

"There's the ongoing three phase 3 studies, and I think if the phase 3 study confirmed that this is effective, it would be the standard care," Dr. Ueno predicts. "Two drugs showed new choices in HER2 metastatic breast cancer."

And when it comes to the future of breast cancer care, Dr. Ueno says the future looks bright. 

"With HER2 metastatic disease, clearly there's going to be more drugs. I just mentioned two drugs, but there are also other promising drugs. So that's a very hopeful thing for the patients because they will have multiple choices, and this will help to keep the patients surviving with a good quality of life," he predicts. "I predict that there's going to be a more dramatic improvement in terms of disease control and improved survival."

In terms of practice-changing events, one is definitely of note: KEYNOTE-522 — but only if it gets approved by the FDA. Dr. Ueno says approval would be ground-breaking.

"If KEYNOTE-522, as it is, is approved by FDA to be practiced, that means that all triple-negative breast cancer patients will be recommended with immunotherapy (pembrolizumab) containing preoperative chemotherapy regimens," he says, which is practice-changing because "everybody will get exposed to immunotherapy unless there's a contraindication. So that's interesting and somewhat concerning because let's say everybody gets immunotherapy therapy, then the disease comes back — what are you going to do? Now it's an immunotherapy-resistant disease."

“One puzzling thing about the immunotherapy is why atezolizumab did not achieve an improvement in pathological completed response like pembrolizumab when added to the preoperative chemotherapy? We will need to look at the data more carefully to understand where is the difference stems from.”

Dr. Ueno specializes in inflammatory breast cancer and was excited about the change in staging. 

"Currently," he explains, "if you're diagnosed with inflammatory breast cancer, everybody's considered as stage III. But this stage III could be divided into IIIA, IIIB, IIIC. But traditional staging is based on the size of the tumor or characteristics or lymph node involvement."

However, under a proposed new system, the classification is a little different: The AJCC 8th version came up with what is called "prognostic staging," which considers ER status, PR status, HER2 status, and nuclear grade.

"It helps to explain to the patient much more clearly what is [their] prognosis rather than simply say everybody's bad," Dr. Ueno says.

In addition, there was also an "overflow" of genomic data and liquid biopsy studies, which will help for the future research and clinical practice. 

"I think we will see a lot of interesting stuff in the near future," he says, "and how we will be practicing in the future could be dramatically different."

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