SHARE: News from ASCO 2014 re: Metastatic Breast Cancer with Dr. Don Dizon

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Dr. Don Dizon presents news from the annual meeting of the American Society of Clinical Oncology (ASCO) as it relates to women and men living with metastatic breast cancer (MBC). Dr. Dizon is …

Dr. Don Dizon presents news from the annual meeting of the American Society of Clinical Oncology (ASCO) as it relates to women and men living with metastatic breast cancer (MBC). Dr. Dizon is Associate Professor at The Warren Alpert Medical School of Brown University and a board certified medical oncologist. This presentation was given on June 14, 2014. Hear the full recording:

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  • 1. ASCO 2014 Metastatic breast cancer Don S. Dizon Massachusetts General Hospital Harvard Medical School
  • 2. Three themes Source: http://understandcancerin60minutes.wordpress.com/2013/12/12/surgical-removal-of-primary-tumor-and-axillary-nodes-in-women-with-metastatic-breast- cancer/comment-page-1/
  • 3. Zoledronic acid: Every 12 weeks is AOK Hortobagyi G, et al. LBA9500
  • 4. Managing bone metastases Agent Formulation Denosumab (D) SQ injection Bisphosphonates (IV) Zoledronic acid (ZA) Pamidronate (P) IV Bisphosphonates (PO) Clodronate Ibandronate Oral
  • 5. Managing bone metastases: OPTIMIZE-2
  • 6. Bisphosphonates do not influence survival
  • 7. A positive trial for survival • One trial showed that a research intervention resulted in: • Improvement in OS at one year • Improvement in median OS
  • 8. ENABLE-3 Bakitas M, et al. Abstr 9512
  • 9. The Intervention Palliative-care consult Charting your course (Telephone) -- What is palliative care? Problem solving, coping -- Self-care and Symptom management -- Communication, Decision-Making, Advance Care Planning -- Life Review -- Forgiveness -- Creating a Legacy
  • 10. What did not change? •Intervention had no significant impact on: • Depression scores • Resource utlization including: • Hospital days (5 vs 6 days) • ICU days (median in both groups was 0) • ED visits (median in both groups was 1) • Chemo in the last 2 weeks of life (4 vs 3 patients)
  • 11. Palliative care is important
  • 12. Communication is key
  • 13. Relief for sexual dysfunction: Vaginal DHEA • ASCO 2014: Barton, et al. • RCT (Alliance N10C1) • Women with breast or gyn cancer (n=441) • Vaginal DHEA (3.25 v 6.5 mg) versus placebo • Results: • All 3 arms had improvement in symptoms • At 12 weeks, DHEA improved sexual satisfaction significantly • Effect size based on FSFI: +0.3-0.6 • Side effects with DHEA: voice change, headache Presented by: Don S Dizon MD
  • 14. Therapeutic news • No results that will add to or change standard of care • Important directions from other malignancies to be gained • Molecular therapy, work is preliminary
  • 15. Potential in MBC? Treatment Data from ASCO 2014 Immunotherapy Melanoma (LBA9008, 9000-9003): Ipilimumab, Nivolumab Early-stage breast cancer (Abstr 1098): Cryoablation + Ipilimumab T-cell therapy Cervical cancer (LBA3008): Activated T-cells in HPV+ cervical cancer Chemohormonal therapy Prostate cancer (Docetaxel plus adrogen deprivation therapy in metastatic prostate cancer) Combination therapy Ovarian cancer (LBA 5500): Phase II of cediranib (angiogenesis inhibitor) plus olaparib Breast cancer (Abstr 2510): Phase I of PI3K inhibitor (BKM1120) plus olaparib
  • 16. Studies of note
  • 17. No data at ASCO: Implications for MBC
  • 18. Quality in Oncology Clinically meaningful outcomes is an ASCO initiative • Costs are going up • Defining efficacy is non-standard • Reports of toxicity are not consistent J Clin Oncol 2014; 12: 1277
  • 19. ASCO • Working groups to determine clinically meaningful outcomes • Objective: establish consensus among experts • Consensus view: “Relative improvement in median OS of at least 20% are necessary to define a clinically meaningful improvement in outcome.” • Scenario of these viewpoints: • Metastatic disease, receiving first-line systemic treatment
  • 20. ASCO: Viewpoint on Targets
  • 21. What ASCO paper is NOT • Not a recommendation • Not a guideline • Not criteria for drug approval • Not to be used to make decisions on current treatment
  • 22. What ASCO paper IS • An example of how clinical trials should be designed • A Call to Arms for: • Patients • Patient Advocates • Clinical investigator • Call: DEMAND better, RAISE expectations “The outcomes discussed here can only be considered aspirational at this time”
  • 23. What this means for patients with MBC • No changes to standard treatment and how decisions on your care are made. • There is nothing new re: dilemma of costs/toxicity/efficacy
  • 24. The Bottom Line
  • 25. Quality of Care is important Project launched on Cosano crowdsourcing platform What is the role of preventative medicine for patients already living with metastatic breast cancer Big data project using MGH datasets
  • 26. Quality of Care is important Goals: • Describe how preventative methods (mammography, colonoscopy, pap smears, aspirin use, screen for dyslipidemia) are used in women with advanced or metastatic breast or ovarian cancer • Determine if there are women who would benefit from preventative screening To support this project, visit consano.org
  • 27. Thank you @drdonsdizon