Breast Cancer KOL 2_July 2022乳腺癌Kol访谈-英国

KOL Insight on Breast Cancer (July 2022)

Key Points:

1. Patient Selection and Therapy Sequencing:

   • HR+/HER2- Breast Cancer:

     • Identifying patients who need additional therapies is crucial.
     • Clarifying resistance pathways remains challenging.
     • Sequencing therapies requires significant work.
     • Tumor dormancy and its drivers are important.
     • Determining the optimal timing for treatment is necessary.

   • HER2+ Breast Cancer:

     • Treatments have become highly effective in early stages.
     • Challenges include optimizing treatment for individual patients.
     • Personalized medicine aims to reduce unnecessary exposure to treatment.
     • Trials for de-escalation are ongoing.

2. Current Practices and Challenges:

   • Systemic Therapy vs. Surgery:
     • Many patients are not receiving systemic therapy upfront, despite being eligible.
     • Hospitals often follow established pathways without considering patient needs.
     • Clinical trials are not widely offered, leading to limited access to new therapies.

3. Emerging Therapies:

   • Tecentriq in Neoadjuvant Setting:

     • Outcomes are already excellent, making widespread adoption challenging.
     • Patient selection for response is critical.
     • All-comer approaches are no longer viable in HER2+ breast cancer.

   • Immune Checkpoint Inhibitors (ICIs):

     • Potential role exists, but further refinement of the target population is needed.
     • Understanding which cancers are immune-responsive is lagging.
     • Translational research is essential for success.

   • Enobosarm:

     • Fast-track approval indicates potential but requires further development.
     • Androgen receptor targeting remains complex due to conflicting data.
     • More effective ways of targeting breast cancer are being explored.

4. Safety and Long-term Considerations:

   • Enhertu:
     • Long-term safety is crucial, especially regarding potential sequelae after treatment.
     • Balancing efficacy and toxicity is important.
     • Therapeutic window of these drugs needs careful evaluation.

5. Diagnostic and Prognostic Factors:

   • Diagnosis:

     • Most patients are diagnosed through screening, while others present with symptomatic breast cancer.
     • Screening can sometimes miss advanced cases.

   • Biomarkers:

     • Estrogen receptor and HER2 are mandatory for initial diagnosis.
     • Some centers use progesterone receptor and Ki-67 tests.
     • Genomic tests like Oncotype DX may be used for HR+/HER2- breast cancers.
     • BRCA1/2 testing is done for patients with strong family history or those under 40 with triple-negative breast cancer.

6. Patient Stages and Proportions:

   • Metastatic vs. Early Stage:

     • 20-25% of patients are HER2+.
     • 15-20% are triple-negative.
     • The rest are HR+/HER2-.

   • Relapse Rates:

     • 80% of patients initially diagnosed with early-stage breast cancer relapse to late-stage.

7. Clinical Trials:

   • Trial Participation:
     • Approximately 50% of patients treated receive clinical trials.
     • This rate is higher due to running a trial-based practice.

8. Unmet Needs:

   • HR+/HER2- Breast Cancer:

     • Identifying patients needing additional therapies.
     • Clarifying resistance pathways.
     • Optimizing therapy sequencing.
     • Addressing tumor dormancy and optimal treatment timing.

   • HER2+ Breast Cancer:

     • Optimizing treatment for individual patients.
     • De-escalation strategies.
     • Understanding resistance mechanisms.
     • Managing brain metastases.

These insights highlight the complexities and evolving landscape of breast cancer treatment, emphasizing the need for personalized and targeted approaches.