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ESMO SUMMIT LATIN AMERICA 2019Current Standards and Practice
Changing Studies in Advanced Breast Cancer in 2018
Enrique Diaz-Canton, MD MScAssociate ProfessorDeputy
ChairmanEducational ProgrammeMedical OncologyInstituto
Universitario CEMICBuenos Aires, Argentina
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CONFLICT OF INTEREST DISCLOSURE
Advisory Board. Member. Roche
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OBJECTIVES OF THE PRESENTATION
Current status of Metastatic Breast Cancer (MBC)
Therapeutic ways available Already approved Promising Algorithms
in each subtype
Are we ready to move beyond the traditional three-tiered breast
cancer subtyping toundergo treatment decisions?
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MBC (GLOBAL DATA 2005-2015)Cordoso F et al. The Breast 2018
0.5 million of deaths/year
Slight improvements in outcomes 1992-1992 23,3% 5-year OS
2005-2011 25.9% 5- year OS
Failing in patient information
Missing the foucus in quality of life
High economic burden
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MBC TREATMENT: OBJECTIVES
Cure (rare)
Prolongation of progression-free survival (PFS) & Overall
survival (OS)
Sympton management
Avoid treatment complications
Improve quality of life
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OBJECTIVES OF THE PRESENTATION
Current status of Metastatic Breast Cancer (MBC)
Therapeutic ways available Already approved Promising Algorithms
in each subtype
Are we ready to move beyond the traditional three-tiered breast
cancer subtyping toundergo treatment decisions?
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STATUS OF CDKi 2018
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Three highly effective drugs in prolonging PFS HR around 0.55;
OS numerical in Paloma 2
Early and sustained benefit
Even in visceral disease (>50% of the studies)
In 1st and 2nd line
Either pre & postmenopausal
With different ET backbones (AI, Fulvestrant &
Tamoxifen)
Different toxicity profile
CDK4/6i 2018: CONCLUSIONS
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HR(+)/HER2(-): TAKE HOME MESSAGE (THM)
ET preferred option unless visceral crisis or endocrine
resistance.Pre-menopausal OFS/OFA, then Rx same way as
post-menopausalwomen with ET+/-targeted therapies. If declines
OFS/OFA: Tamoxifen.Best 1st line ET (type & duration) of
adjuvant ET & TFI.AI, tamoxifen, or fulvestrant for
pre-menopausal women with OFS and post-menopausal women.CDKi + ET
prolong PFS and QOL in naive, pre-treated, pre, post-menopausal
with different ET-backbonesEverolimus + ET valid option (PFS) for
pre-treated patientsOptimal sequence of endocrine-based therapy is
uncertain
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HER 2 (+): THMCombined Her2 blockade + ChT should be offered to
most of the patients.
Upon progression T-DM1 has shown improvement in OS in phase III
trial
For later lines, trastuzumab + non-used before ChT, lapatinib,
ET or pertuzumab (if notused before)
In triple + patients with indolent behaviour ET+AntiHer 2 agents
may be considered
It is advised to mantain the Her2 pathway blocked
For how long? no data…
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TNBC: THM
ChT remains the only available standard treatment option for
non-gBRCA advancedTNBC
No specific recommendation regarding types of agents, posible
exception? platinuncompounds.
Different subtypes may lead to developements of specific
therapies.
Previously treated gBRCAm patients: olaparib & talazoparib
prolonged PFS & QOL
Role of atezolizumab + ChT (FDA-approved in March 8th 2019)
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Current status of Metastatic Breast Cancer (MBC)
Therapeutic ways available Already approved Promising Algorithms
in each subtype
Are we ready to move beyond the traditional three-tiered breast
cancer subtypingto undergo treatment decisions?
OBJECTIVES OF THEPRESENTATION
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FDA/EMA 2018: Olaparib & Talazoparib
Elevated RR with platimun salts
3 months improvement PFS & QOL with PARPi vs standard
Chemotherapy
No comparison of platinum vs PARPi
Optimal sequence? Combination? Role beyond BRCA
TBCRC046 trial: olaparib for germline/somatic mutations DNA
repair genes other tan germline BRCA1/2
BRCA (+) & PARPI
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Germline Profiling:
BRCA 1-2 testing in Her2(-) if eligible for PARPi Use of
Platinum in TNBC ?????? Olaparib (OlimpiaD) & Talazoparib
(Embraca).
Tumor profiling: High clinical impact is infrequent (MSI-high
1.5%) Consider in context of: Available agents, clinical trials,
and other effective
therapies
BREAST CANCER GENOMICS: THM
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SAFIR-01 (n 423) “Targeteable” mutation in 46%. 13% matched to
clinical trial (RR 9%)
MSK IMPACT (n >10000): “Actionable” mutation in 36%. 11%
matched to clinical trial.
SHIVA (n 741): 26% randomized targeted therapy vs ChT. PFS 2,3 m
both arms and less G3/4 toxicity in the ChT arm.
Ongoing: NCI MATCH, TAPUR, etc.
CAN TUMOR PROFILING GUIDE USE OF TARGETED THERAPY?
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Global effort to improve outcomes & QOL.
Broad our kwowledge in the use of available agents (CDKi,
mTORi), and promisingagents (PI3KAi, Her2i, immunotherapy)
Consider routine germline testing, but be careful of tumor
profiling outside the setting of clinical trials.
Clinical trial participation is needed globally
MBC 2018: FINAL THM
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THANK YOU
[email protected]
ESMO Summit �LATIN AMERICA 2019Conflict of interest
disclosureObjectives of the PresentationMBC (Global Data
2005-2015)MBC Treatment: ObjectivesObjectives of the
PresentationSlide Number 7Slide Number 8Slide Number 9Slide Number
10Slide Number 11Slide Number 12Slide Number 13Slide Number 14Slide
Number 15Slide Number 16STATUS of CDKi 2018CDK4/6i 2018:
ConclusionsSlide Number 19Slide Number 20Slide Number 21Slide
Number 22Slide Number 23Slide Number 24Slide Number
25HR(+)/Her2(-): Take home message (thm) Slide Number 27Slide
Number 28Slide Number 29Slide Number 30Slide Number 31Slide Number
32Slide Number 33HER 2 (+): thmSlide Number 35Slide Number 36Slide
Number 37Slide Number 38Slide Number 39Slide Number 40Slide Number
41Slide Number 42Slide Number 43Tnbc: thmObjectives of the
PresentationSlide Number 46BRCA (+) & PARPiBreast Cancer
Genomics: THMCan Tumor Profiling guide use of Targeted Therapy?MBC
2018: Final THMThank you
