Closing Thoughts on Metastatic Breast Cancers

The panel provides key takeaways for the treatment of metastatic breast cancers.


Hope S. Rugo, MD: We've had an amazing discussion. I think everybody has contributed tremendously, and it's been fascinating to hear the clinical trial aspect, what questions we have, and then coming from the payer aspect as well.

This has been an interesting discussion talking about some very broad areas where we've made a lot of advances and still have some questions. It's really been an informative discussion. As we close up, thinking about the areas we talked about—our 4 broad areas—I would appreciate if each of you could give me a couple of sentences or thoughts, your summary about what we've talked about. We’ll start with Tiffany. You want to give us a quick thought?

Tiffany A. Traina, MD: One takeaway for me in this discussion is the amazing drugs that we have for HER2-positive breast cancer, and I’m envious in the triple-negative space. I'm excited about having more coming soon to replicate the successes seen in HER2-positive disease when you identify the right target and then have a plethora of options to biologically shut down that target. I think it's been a really wonderful discussion, and I appreciate Dr. Fox's input on how we'll pay for this and get it to our patients.

Hope S. Rugo, MD: Priyanka?

Priyanka Sharma, MD: In addition to the excitement in the HER2 space, these strides that have been made in hormone-positive metastatic disease with the CDK4/6 [cyclin-dependent kinases 4 and 6] and PI3 kinase inhibitors really have been tremendous. A lot of these patients are now living for years and years with metastatic disease. That excites me, and the potential of possibly having more oral chemotherapy options down the line is definitely very encouraging.

Hope S. Rugo, MD: Claudine?

Claudine J. Isaacs, MD: I echo again what's been said. I think the HER2-positive space is really the most exciting space right now in terms of what we can do or will be able to do in clinic very soon to offer yet more life prolonging therapies, and in the hormone receptor-positive space with the PI3 kinase inhibitors following to think of something that we can be doing following CDK4/6 inhibitors. Again, I think we don't know how to apply some of these results to our patients in the hormone receptor-positive space because not all of the patients on these trials had CDK4/6 inhibitors, but I think we have more options for our patients.

All of what we've talked about, regarding oral agents and the pluses and minuses, I do think that that one of the take home-messages is that oral isn't always better, but it can be, and we should be making careful choices with our patients in terms of looking at the risk profile, their tolerability, and how we approach this on an individual basis.

Hope S. Rugo, MD: John?

John Fox, MD, MHA: Three quick things. One, I’m a huge proponent of biomarker testing and trying to ensure that we get patients on the therapy that they're most likely to respond to. We've talked a lot about predictive response markers, but there are also some nonresponse markers in non–small cell lung cancer. STK11, for example, predicts you won't respond to immunotherapy, so we have to be looking more broadly at biomarkers. Second, this is becoming so complex. This conversation today highlighted that, the complexity in this space in just breast cancer. A lot of payers are turning to oncology benefit management companies to help sort that out because we don't have the expertise or competence to do that anymore.

Third, for all of you to noodle on, when you become not only the provider but also the payer, how do you look at these data as a 1-month survival benefit? Is that as impressive when a drug costs $50,000 versus $40,000 a month? I think Medicare is increasingly driving us in that direction where payer and provider are going to be synonymous.

Hope S. Rugo, MD: I think those comments were phenomenal and excellent, and I think they really summed up a lot of our discussions and where we're moving to with the data we have at present. My additional comment at the end is that maybe one of the areas that we will be able to afford these therapies is moving effective treatments to the right population with early stage disease, so that we're treating more patients with effective therapy, having fewer patients in the metastatic setting, and in the long run a shorter duration of therapy and less toxicity. That's my big hope moving forward. Although it takes us a long time to get to those end points, maybe we're shortening that time now by working in the neoadjuvant setting with trials that are powered to look at event-free survival.

With that I'm going to wrap up. I want to thank everybody for participating during this COVID-19 [coronavirus disease 2019] pandemic and taking time outside of your really busy lives to participate and discuss this for our viewing audience.

Thank you again and to our viewing audience, we hope you found this AJMC® Peer Exchange discussion to be useful and informative. Thank you.

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