Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Report Back from ASCO on Metastatic Breast Cancer

12,687 views

Published on

Dr. Anne Moore, Medical Director of the Weill Cornell Breast Center, shares her experiences from the American Society of Clinical Oncology's June 2017 Conference. She also updates us on the latest research from the conference as it relates to metastatic breast cancer.

Published in: Healthcare
  • Be the first to comment

Report Back from ASCO on Metastatic Breast Cancer

  1. 1. Metastatic breast cancer ASCO 2017-What’s new? Anne Moore, MD and Linda Vahdat, MD Weill Cornell Breast Center SHARE Webinar June 20, 2017
  2. 2. Breast cancer in the US-2017 New esFmated data •  3.5 million women are living with a history of breast cancer –  EsFmate 35,000 men •  155,000 women are living with a history of metastaFc breast cancer •  26,500 women are living 10 years or more with metastaFc breast cancer MarioPo, Cancer Epidemiol Biomarkers Prev 2017;26:809
  3. 3. Breast cancer in the US-2017 “With opFmal care, women with MBC can and oYen do live for years with reasonable quality of life, albeit undergoing constant treatment to keep their disease under control.” MarioPo, Cancer Epidemiol Biomarkers Prev 2017;26:809
  4. 4. What have we learned in the past few years?
  5. 5. Every breast cancer is different! DC Koboldt et al. Nature 000, 1-10 (2012) doi:10.1038/nature11412
  6. 6. Although all individual breast cancers are different, there are 4 groups •  Hormone receptor posiFve – Luminal A – Luminal B •  Hormone receptor negaFve •  Her 2 posiFve
  7. 7. Every breast cancer is different and there are frequently differences between the primary cancer and the metastasis Biopsy of the metastasis is very important! Amir E et al. JCO 2012;30:587-592
  8. 8. Every breast cancer is different and there are frequently differences between the primary cancer and the metastasis Biopsy of the metastasis is very important! Amir E et al. JCO 2012;30:587-592 37% of the Fme, the ER/ PR or HER 2 in the metastasis is different from the original primary cancer
  9. 9. Should all breast cancers, primary or metastaFc, be tested for “next generaFon sequencing”? Precision Medicine analyses such as FoundaFon One test for gene mutaFons in the cancer… At present, this is not a rouFne analysis for breast cancer. There was no new informaFon at ASCO that leads me to think this should be done rouFnely.. But keep asking!
  10. 10. ASCO 2017 •  Held in Chicago-almost 40,000 aPendees from more than 150 countries. •  Papers with new findings about cancer were submiPed and selected for presentaFon --- almost 12,000 were published in the Proceedings
  11. 11. ASCO 2017-almost 12,000 abstracts
  12. 12. ASCO 2017: Breast Cancer Highlights Hormone receptor (ER and/or PR posiFve) metastaFc breast cancer What are acFve treatments for this disease? •  Postmenopausal –  Aromatase inhibitor •  Anastrazole or Letrozole (non-steroidal) •  Exemestane (steroidal) –  Aromatase inhibitor with Cell Cyclin inhibitor •  Palbociclib (Ibrance) •  Ribociclib •  Abemaciclib
  13. 13. Letrozole and Palbociclib (Ibrance) 2015-PALOMA 1 trial showed that women with ER + metastaFc breast cancer who took letrozole + palbociclib as their first treatment aYer the diagnosis of metastaFc disease had twice as long a response to the treatment than if they took the letrozole alone. 2017-Does that mean they will live longer if they start the 2 medicaFons immediately at the Fme of diagnosis of metastaFc breast cancer?
  14. 14. ASCO 2017
  15. 15. PALOMA 1-FOLLOW UP 2017 Overall survival was not affected if a woman took letrozole alone or letrozole + palbociclib at the Fme of diagnosis of metastaFc breast cancer. •  This is probably because we have so many other medicines to use if a woman has progression of the disease aYer first-line therapy (whether the letrozole alone or letrozole + palbociclib). •  BUT she may have a longer Fme before she has to change medicines if she has letrozole + palbo as compare to letrozole alone
  16. 16. What does this mean for you if you have a first metastasis of ER+ breast cancer ? •  Aromatase inhibitor alone (letrozole) may be the best treatment for you if the disease is “indolent” and not fast growing •  Letrozole + palbociclib might be bePer for you if the disease is more acFve and we need a faster response to treatment
  17. 17. ASCO 2017 MONARCH 2 TRIAL •  ER posiFve metastaFc breast cancer •  A different cell cyclin inhibitor, abemaciclib, and a different hormone treatment, fulvestrant (Faslodex) in a different group of women.
  18. 18. ASCO 2017
  19. 19. ASCO 2017 ER posiFve metastaFc breast cancer A different cell cyclin inhibitor and a different hormone treatment in a different group of women •  MONARCH 2-Good news – The women with fulvestrant AND the new drug, abemaciclib had less progression of their disease at a follow up of 19 months compared to the women with fulvestrant alone – Will these women live longer by adding abemaciclib to the fulvestrant?
  20. 20. ER + breast cancer •  We have a new approach (cell cyclin inhibiFon) and more choices to treat this disease •  Longer Fme before we switch to chemotherapy
  21. 21. MetastaFc HER 2 PosiFve breast cancer
  22. 22. MetastaFc HER 2 posiFve breast cancer •  HercepFn (trastuzumab) is a targeted drug for the HER 2 receptor. •  When combined with chemotherapy, it is very acFve against metastaFc disease; not very acFve when given alone •  How about “dual” blockade of the HER2 receptor-using 2 drugs against HER2 instead of one drug?
  23. 23. MetastaFc HER 2 posiFve breast cancer: Dual blockade •  Pertuzumab + HercepFn + taxotere (Cleopatra trial) is more acFve than HercepFn and taxotere alone for metastaFc disease-a new standard of care for metastaFc breast cancer •  LapaFnib (a pill) + HercepFn +chemotherapy •  NeraFnib (a pill) + HercepFn + chemotherapy
  24. 24. MetastaFc HER 2 posiFve breast cancer: Dual blockade: MARIANNE TRIAL •  Women with metastaFc her 2 + breast cancer received one of these treatments as first line: – HercepFn + taxotere or taxol – T-DM1 (Kadcyla: hercepFn aPached to a chemo drug, maytansine) – T-DM1 + Pertuzumab (Perjeta)=dual blockade •  All the treatments were equal-dual blockade was not superior- •  This does show the value of TDM-1
  25. 25. Triple negaFve breast cancer •  All triple negaFve breast cancers are not the same although all are ER, PR and HER 2 negaFve •  Much research on figuring this out so we can find targets to treat •  How about immunotherapy?
  26. 26. Triple negaFve breast cancer •  How about immunotherapy? •  Pembrolizumab (Keytruda) is acFve in some cancers such as melanoma or lung cancer
  27. 27. Immunotherapy has promise in metastaFc breast cancer
  28. 28. Immunotherapy in Breast Cancer •  How do we select the right paFent? •  How do we select the right tumor? •  How do we select the right paFent with the right tumor?
  29. 29. BRCA mutaFon carriers with metastaFc breast cancer •  We have an acFve new drug: Olaparib, a PARP inhibitor
  30. 30. BRCA mutaFon carriers with metastaFc breast cancer
  31. 31. BRCA mutaFon carriers with metastaFc breast cancer
  32. 32. Highlights of ASCO 2017 Opening new pathways •  For paFents with BRCA mutaFon – PARP inhibitor in BRCA mutaFon carriers-aimed at the specific problem caused by the gene mutaFon •  For paFents with ER + breast cancer: – Cell cyclin inhibiFon – aimed at slowing down cell growth and making cells more sensiFve to anF- estrogen therapies
  33. 33. Highlights of ASCO 2017 Opening new pathways •  For paFents with HER 2 + breast cancer – Expanding on the success of HercepFn –adding more anF-HER 2 drugs •  For paFents with Triple NegaFve breast cancer – Breaking the code •  Immunotherapy—just the beginning?
  34. 34. Clinical trials at Weill Cornell Medicine
  35. 35. Weill Cornell Breast Center Clinical Trials – Adjuvant Trials ER+/PR+ TNBC HER2+ BRCA+ •  S1207 : Phase III Randomized, Placebo- Controlled Clinical Trial EvaluaFng The Use of Adjuvant Endocrine Therapy +/- One Year of Everolimus •  POSITIVE: Pregnancy Outcome and Safety of InterrupFng Therapy for Women with Endocrine Responsive Breast Cancer •  S1418 : A Randomized, Phase III Trial to Evaluate the Efficacy and Safety of MK-3475 as Adjuvant Therapy for Triple Receptor-NegaFve Breast Cancer •  EA1131: PlaFnum Based Chemotherapy or ObservaFon in TreaFng PaFents With Residual Triple- NegaFve Basal-Like Breast Cancer Following Neoadjuvant Chemotherapy •  NSABP B55 : A randomized phase III Study to access the efficacy and safety of olaparib versus placebo as adjuvant treatment in pt with Germline BRCA1/2 mutaFons Targeted SupporFve Care/ CorrelaFve/ Biobank •  Triple Nega<ve Breast Cancer Program: Clinical Database and Tissue CollecFon Project for the Study of Breast Cancer •  Stress-Reduc<on & Self-Healing: A Pilot Study of Guided MeditaFon •  Precision Medicine: To idenFfy the frequency and rate of acFonable mutaFons in advanced cancers •  Biomarkers: To idenFfy the frequency and rate of acFonable mutaFons in advanced cancers •  SCP Sa<sfac<on Survey: PaFent and Physician SaFsfacFon Survey of Survivorship Care Plans
  36. 36. Weill Cornell Breast Center Clinical Trials – MetastaFc Trials ER+/PR+ TNBC HER2+ BRCA+ •  E2112: A Randomized Phase III Trial of Endocrine Therapy plus EnFnostat/ Placebo in Men and Women with Hormone Receptor-PosiFve Advanced Breast Cancer •  IMMU-132-01: A Phase II Study of IMMU-132 (hRS7- SN38 AnFbody Drug Conjugate) in PaFents with Epithelial Cancer •  MILLENNIUM: A Phase 1b/2 Study of MLN0128 in CombinaFon With Exemestane or Fulvestrant Therapy in Postmenopausal Women With ER+/ HER2- Advanced or MetastaFc Breast Cancer •  AAAM1906: Phase II Trial of RuxoliFnib in CombinaFon with Trastuzumab in MetastaFc HER2 PosiFve Breast Cancer •  PUMA: A Phase III Trial of NeraFnib + Capecitabine Versus LapaFnib + Capecitbine In PaFents With HER2+ MetastaFc Breast Cancer •  Macrogenics: A Phase 3, Randomized Study of Margetuximab Plus Chemotherapy vs Trastuzumab Plus Chemotherapy in the Treatment of PaFents with HER2+ MetastaFc Breast Cancer •  CELLDEX : A Randomized MulFcenter Pivotal Study of CDX-011 (CR011-vcMMAE) in PaFents with MetastaFc, GPNMB Over-Expressing, Triple-NegaFve Breast Cancer •  Rexahn: A MulF- Center, Dose Finding, Open Label, Phase 1 study of RX_5902 in Subjects with Advanced or MetastaFc Solid Tumors •  Oncotherapy: A Phase I Study of OTS167PO, a MELK inhibitor, in PaFents with Advanced, Triple NegaFve Breast Cancer •  Pharma Mar: A MulFcenter Phase II Clinical Trial of PM01183 in BRCA 1/2- Associated or Unselected MetastaFc Breast Cancer Targeted •  Genentech Pathway: Open- label Phase IIa Study EvaluaFng Trastuzumab/ pertuzumab, ErloFnib, Vemurafenib, and Vismodegib in Pt's W/ Advanced Solid Tumors With MutaFons or Gene Expression AbnormaliFes PredicFve of Response to One of These Agents •  LY2157299: LY2157299 Monohydrate and Radiotherapy in MetastaFc Breast Cancer •  TLR7: Phase I/II study of TLR7 agonist Imiquimod, Cyclophosphamide, and Radiotherapy in Breast Cancer PaFents with Chest Wall Recurrence or Skin Metastases SupporFve Care/ CorrelaFve/ Biobank •  Triple Nega<ve Breast Cancer Program: Clinical Database and Tissue CollecFon Project for the Study of Breast Cancer •  Stress-Reduc<on & Self-Healing: A Pilot Study of Guided MeditaFon •  Precision Medicine: To idenFfy the frequency and rate of acFonable mutaFons in advanced cancers •  Biomarkers: To idenFfy the frequency and rate of acFonable mutaFons in advanced cancers •  SCP Sa<sfac<on Survey: PaFent and Physician SaFsfacFon Survey of Survivorship Care Plans
  37. 37. The Future The future is bright… Our clinical trials are thriving… Support research! Thank you to my colleagues at the Breast Center, Drs Andreopoulou, Cigler and Vahdat And thank you to Dr Maura Dickler for sharing her recent presentaFon on Highlights from ASCO

×