A blog on the latest developments in breast cancer diagnosis and treatment
2018 – A WATERSHED YEAR IN BREAST CANCER TREATMENT
FDA Approves New Drugs to Treat Hormone-Receptor Positive Breast Cancer
2018 was an amazing year for breast cancer treatment breakthroughs! The FDA approved three new drugs (Palbociclib (in 2016), Ribociclib, and Abemaciclib (in 2018)) for women with hormone-receptor positive (estrogen and/or progesterone receptor) breast cancers. These medications enhance the duration of response to anti-estrogen treatments for women with metastatic breast cancer when combined with an aromatase inhibitor (Anastrozole, Letrozole, Exemestane). Women maintain an excellent quality of life on an all-oral regimen, and responses can last for years. Due to these great results, there are several ongoing trials evaluating the use of these medications for women with early-stage breast cancer.
Clarity on Who Benefits from Chemotherapy
We also saw the release of long-awaited data on the intermediate Oncotype DX score. Oncotype DX is a test which is run on a breast cancer specimen after it is removed from the patient’s body. Practice has been that women with a low-risk score did not benefit from chemotherapy, while women with a high-risk score needed chemotherapy. Unfortunately, a large percentage of women fell into a middle risk group for which chemotherapy was of uncertain benefit. The TailorRX study results revealed that for women over 50, patients with an Oncotype DX score over 25 benefitted from chemotherapy and below that did not. For women under 50, some benefit was still identified in patients with a score above 15. These stunning results will make the decision regarding chemotherapy much easier for most women.
In the triple-negative breast cancer arena, there was a blockbuster breakthrough with immunotherapy. We saw that using immunotherapy in combination with chemotherapy improved survival in women with metastatic breast cancer. Immunotherapies are treatments that “train” or “stimulate” the patient’s own immune system to recognize and fight cancer. These treatments have had dramatic benefits in multiple tumor types, including melanoma, renal cell carcinoma, and lung cancers, but until now were not very effective for breast cancer. Results of the Impassion130 trial demonstrated longer survival in women treated with Atezolizumab (Tecentriq) and nab-paclitaxel (Abraxane) when compared to chemotherapy alone. Nab-paclitaxel is a standard first-line chemotherapy drug for metastatic breast cancer. Atezolizumab is an antibody that targets PDL-1, a protein that allows some cancer cells to “hide” from the immune system. We expect that over the next several years combining immune therapies with each other, and with other drugs, will lead to more dramatic breakthroughs.
BRCA-Related Breast Cancer Treatment
Women with BRCA-related breast cancers saw benefit from expansion of the Parp-inhibitors in treatment. Several new inhibitors were approved, including approval for maintenance therapy after an initial response to chemotherapy. Look for more on these in a future newsletter!
A New Standard of Treatment for Early-Stage Her2/new-positive Breast Cancer
Lastly, for Her2/neu-positive breast cancer patients, the long-awaited KATHERINE trial results were published. In this study, patients with HER2-positive early breast cancer underwent chemotherapy with Trastuzumab (Herceptin) before surgery. Those who were found to have residual cancer in the breast or axilla at surgery received adjuvant T-DM1, or trastuzumab, for 14 cycles. TDM-1 is the Trastuzmab antibody (Herceptin) linked to a chemotherapy drug called emtansine, which gets delivered only to the Her2/neu positive breast cancer cells. The study found that women who received the TDM-1 had much better chances of survival and of remaining cancer-free. This sets a new standard for all early-stage Her2/neu- positive patients to receive chemotherapy before surgery, and for the change to TDM-1 in those who do not get a complete response to Herceptin-based treatment.
More to Come!
While there were many more breakthroughs in breast cancer treatment last year, these are considered the biggest! Look for more updates and interesting news in future posts on Breast Cancer Newsflash at www.shadesofpinkfoundation.org!
This entry of the Breast Cancer Newsflash Blog was written by Dr. Laura Nadeau, M.D., F.A.C.P., a hematology specialist in Royal Oak, MI. She graduated from Case Western Reserve University School of Medicine and specializes in hematology, oncology, and more. Dr. Nadeau is a member of the Shades of Pink Foundation Board of Directors.