COMMENTARY

SABCS Promises 'Seismic Tremors' for Breast Cancer

Kathy D. Miller, MD

Disclosures

December 07, 2015

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It's Dr Kathy Miller, from Indiana University. Thanksgiving is done, and many of us are turning our thoughts to the other winter holidays that are afoot. But those of us in the breast cancer world are turning our thoughts towards chilies and tamales and the San Antonio Breast Cancer Symposium. We will be gathering in San Antonio, December 8-12, to talk about the latest developments in breast cancer—both large studies that may change treatment immediately, and some small studies that may give us a view of the future and where the field is headed.

I'll be reporting from San Antonio and interviewing several of the leaders in the field. But I wanted to give you a heads-up about some of the studies that I think might make the news, or ones that I think should make the news.

First off, in the program, you can see the world shift under your feet. For years, the first session of oral presentations at the San Antonio meeting was dominated by studies, both clinical and laboratory, looking at the estrogen receptor: hormone-positive disease, treatment of hormone-positive disease, and the biology that underlies hormone resistance. No longer is hormone therapy king. This year at San Antonio, the lead-off session is all about immunology, tumor-infiltrating lymphocytes, sequencing that drives immune responses or blocks immune responses, and early studies in breast cancer of immunotherapy.

Now, I realize that may seem like a subtle shift, but to those of us who have been in San Antonio for years, this is a huge change and one that clearly tells you where the field is headed and what we're likely to be talking about for the next several years.

There has also been a big controversy in the field about the benefits of adjuvant bisphosphonate therapy, lots of negative trials that have positive subsets in patients with low estrogen levels, and a meta-analysis suggesting benefit.[1] It's been difficult to think about incorporating that into practice. We're definitely going to be talking about that again, as well as we see the results of the first adjuvant denosumab study.[2] It would be fascinating to see whether those results replicate the meta-analysis and maybe give us more clarity about what we should be doing with the bisphosphonates.

Finally, there are two large studies[3,4] that I think will have real importance for us. One is the first randomized study[3] that I'm aware of that looks at additional chemotherapy vs no additional chemotherapy in those patients who had neoadjuvant chemotherapy who still had residual disease. This is a group we know has a very high risk for recurrence, and we have struggled to find any therapy that improves their outcome. We're going to see the first large randomized trial in that space reported and that, if positive, may change practice and may have us thinking about additional chemotherapy in those patients.

A study that should give us pause is one of thousands of patients treated with either breast-conserving surgery or mastectomy that shows overall survival advantage for those patients who are treated with breast-conserving surgery.[4] Now, in an era where (at least in the United States) more patients are opting for mastectomy and for bilateral mastectomy, we might have to pay close attention to the study results, and really think about the shift in that practice and how we approach our patients and discuss those local therapy decisions with them.

I'm sure there will be some surprises. I look forward to meeting with you in San Antonio. If you're there, please look me up. I'd love to see you in person. Otherwise, I hope you'll tune in for our interviews and more detailed insights for some of these and other important topics in the field.

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