Kathy D. Miller, MD


May 27, 2011

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Hi, this is Dr. Kathy Miller back with another one of our Medscape video blogs. Today, I want to give you a quick preview of some of the topics I am looking forward to in the breast cancer session at the American Society of Clinical Oncology (ASCO®) meeting this year. First, I want to tell you about some reorganization. For years, the breast cancer sessions have been divided according to anatomy. We talked about local therapy and adjuvant treatment in one session and treatment of metastatic disease in another session. In many ways, that no longer reflects how we think about the disease in current times. We think about tumors that are estrogen sensitive, HER2 sensitive, and that may be triple negative or BRCA driven. Much of our treatment decisions and choices are made on the basis of the underlying biology. The anatomy is still important, and local therapy issues are still going to be with us. There are still older trials that don't reflect that biology, but we have made the leap. Today, breast cancer sessions are divided on the basis of biology. We will talk about estrogen receptor and HER2-positive disease in one session and triple negative disease in another session. With the triple-negative disease will be trials of cytotoxic therapy that might cross the biologic spectrum, and also trials of local therapies. It's an experiment. See how you like it and please let us know if you think this works. It might be helpful and give more cohesiveness to the sessions.

As to particular trials that I'm looking forward to, let's start with prevention. The MAP3 trial is long awaited and one of the first trials to look at the aromatase inhibitors as potential preventive agents in postmenopausal patients who are at high risk of developing breast cancer. You all know the tamoxifen data and that tamoxifen is quite an effective preventive agent that very few patients will accept. This drug may give those postmenopausal patients another option. If we also look on the prevention side, we have a growing number of patients with identified BRCA abnormalities who may or may not have considered prophylactic surgery but have significant hot flashes and are menopausal. It would be helpful to have actual data on the impact of supplemental estrogen for symptom control in those patients. Susan Domchek and her colleagues have collected those data from a large genetic consortium of about 1200 patients, and that will be really helpful in advising those patients who we will be seeing more frequently.

If we shift to thinking about treatment of patients with active disease, in the adjuvant setting, we will see results of 2 trials. First is a trial looking at whether a longer duration of chemotherapy (6 cycles rather than 4 cycles) is helpful. This is a trial that may give us pause in thinking about some of the control arms of some ongoing trials and some practices that have been widely adopted without data.

We will also see the second large trial looking at the impact of adding bevacizumab in the neoadjuvant setting -- a trial that had a 2-by-2 randomization. In addition to the bevacizumab question, investigators looked at adding other chemotherapies to see whether enhancing or extending the chemotherapy would further improve the benefits. In the metastatic setting, we will finally get to see the actual data from the BiPar trial. You will recall this is the first phase 3 trial looking at a PARP [Poly (ADP-ribose) polymerase] inhibitor, in addition to chemotherapy in patients with sporadic triple-negative disease. In randomized phase 2 trials, this agent had striking results and was presented at the plenary session at ASCO® 2 years ago. In a press release early this year, we learned that in the phase 3 trials, the PARP didn't live up to those expectations. At ASCO® we will actually be able to see the data and hopefully begin the discussion and the investigation about what happened, what is different, what does this tell us, and where do we go from here?

I am sure that there will be surprises in many other topics for us to discuss after the meeting. As I look at the coming attractions, these are the things that I think will be this year's highlights.


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