Adapting Breast Cancer Therapy to the Individual, Not Just the Scan: Lidia Schapira, MD

For a growing number of patients with metastatic breast cancer, long-term survival on targeted and endocrine therapies means living with what increasingly resembles a chronic illness—one that demands a different framework for measuring success, according to Lidia Schapira, MD, FASCO, professor of medicine and director of cancer survivorship at the Stanford Comprehensive Cancer Center and Cancer Institute.

Beyond Response Rates

In an interview at an Institute for Value-Based Medicine® event in San Francisco on August 11, 2026, hosted by The American Journal of Managed Care^®, Schapira said care teams need a conceptual shift away from evaluating treatment success solely through months or years of survival. Instead, she advocated identifying the "least burdensome, effective therapy" for each patient by weighing their values, circumstances, and quality of life alongside disease control. This requires survivorship and palliative care models built around frequent, repeated assessments that track symptom burden and tolerability over the full trajectory of a chronic illness—not just at treatment initiation.

"The issue here is not just to have success with numbers or scans,” she explained, “But really adapt the treatment in a setting of a chronic illness to what's best for that individual with their hopes, with their expectations, and with their limitations, often."

Adherence and Tolerability Are Linked

Turning to endocrine and targeted therapies for metastatic breast cancer, Schapira noted that increasingly precise, biology-driven combinations have improved outcomes but also raised the complexity—and sometimes the symptom burden—of treatment. She cautioned that focusing only on scans and lab results risks missing critical tolerability issues such as nausea, fatigue, cognitive changes, neuropathy, and gastrointestinal or systemic toxicities associated with oral targeted agents.

Motivated patients often find ways to cope with difficult regimens, Schapira said, but adherence and tolerability remain closely intertwined. She called for clinic visits—in person, remote, or via video—to function as safe spaces for honest symptom assessment, where care teams can openly consider treatment holidays, dose adjustments, or substitutions.

For Schapira, that recalibration is the throughline of survivorship care in the era of chronic metastatic disease: treatment decisions guided as much by what a patient can live with as by what a scan can show.