Defining Value for the Treatment of Brain Metastases in Metastatic HER2-Positive Breast Cancer - Episode 17
The impact of COVID-19 on the treatment of metastatic breast cancer in regard to site of care and utilization of telehealth, as well as the evolving treatment landscape with emerging agents in the pipeline.
Sarah Sammons, MD: How has COVID-19 [coronavirus disease 2019] affected the treatment of metastatic breast cancer? We’ve certainly all become gurus in telehealth overnight. Telehealth was not something that anyone at my institution was doing prior to COVID-19, and we now have the platform to use it. We are certainly able and willing. I find it a bit difficult to use telehealth for a majority of patients with metastatic breast cancer. For some patients who are stable on their treatment regimen, if it’s an oral regimen that they’ve been on for a long time and are stable, a telehealth visit is perfectly fine. For a patient who has a large disease symptom burden or for a patient who needs labs and intravenous drugs, and they are coming in to the cancer center anyway, a telehealth visit has not been as effective in those patients. There have been patients with high-symptom disease burden, and there is still value in seeing those patients in front of you, laying hands on them and doing a physical exam.
In patients who are more stable and have been on a treatment regimen, which may be an oral regimen for a long time, we’re utilizing telehealth in those patients. We’ve also implemented a nursing program through a grant where nurses can go to patients’ houses and collect their labs and talk to them about any symptoms of therapy they might be having. For low-risk patients on CDK4/6 inhibitors and endocrine therapy, that is a reasonable model that we should all continue to pursue. For patients on the sicker end, we have still been seeing those patients using all the recommended guideline-directed approaches, such as temperature checking, screening, and mask wearing. That’s been highly effective.
Kevin M. Kalinsky, MD, MS: Treating patients during COVID-19 has proven to be challenging. It’s challenging for everybody: for health care practitioners, for patients, and for their families. I was treating patients in New York City during the peak, and we were all concerned about patients coming into the infusion center and having unnecessary exposures if they really didn’t need it. We were increasingly utilizing oral agents for our patients. Having agents like tucatinib, neratinib, and lapatinib proved to be helpful because we knew that patients could get active agents and not need to come into the infusion center.
The downside is that not all of our patients are compliant. If patients are coming into the infusion center, we know that they’re getting the medicine that we would like for them to be receiving. However, I will say that during COVID-19, it is particularly beneficial to have these oral agents because it could limit potential risk in exposure.
The big picture for patients with HER2 [human epidermal growth factor receptor 2]–positive disease is that the amount of riches that we have for treating patients is only increasing. With these 2 big FDA approvals in the last year, this has only advanced the field.
There are other agents that are also coming down the pike. What’s the role of immunotherapy? There are large studies looking to answer that question. Other agents have been investigated. Others are also early in investigation, including some of the bispecific drugs. What is the role of CAR [chimeric antigen receptor] T cells? There are many things coming down the pike, so I remain optimistic about what our therapeutic landscape looks like for these patients, not only in preventing metastases but also in treating patients who develop metastases and those who have CNS [central nervous system] disease.