Session co-moderator Kevin Kalinsky, MD, MS, the Louisa and Rand Glenn Family Chair in Breast Cancer Research, Director of the Glenn Family Breast Center, and Director of Breast Medical Oncology at the Winship Cancer Institute of Emory University, Atlanta, offered his thoughts on PHERGain to The ASCO Post.
“The study in HER2-positive, hormone receptor–positive patients looked at a noninvasive biomarker—positron-emission tomography (PET) imaging—to determine risk, which guided whether they needed specific therapies or not. It’s important to mention this is not a new concept in oncology. For example, we routinely incorporate imaging in treating patients with Hodgkin lymphoma. We do this because we are interested in patients being able to ‘opt out’ of certain therapies when it’s safe to do so,” he noted.
Kevin Kalinsky, MD, MS
“So, the findings of PHERGain and incorporation of PET imaging are really intriguing…. Seeing 37% of patients being able to avoid chemotherapy altogether is a meaningful number,” he said.
However, although some may think the data are sufficient to begin considering a response-guided approach in the clinic, Dr. Kalinsky was more cautious. For him, a key question pertains to the length of follow-up because patients with hormone receptor–positive disease often experience recurrences beyond 5 years. The current analysis was done after 3 years, so additional follow-up will be important, he added. On a more practical level, in the absence of guideline support, it is often difficult to obtain reimbursement for baseline PET imaging in the early-stage setting, he added.
“I think the data are compelling and we are seeing a signal. But I think questions remain, and we need additional data to answer them,” Dr. Kalinsky concluded.
DISCLOSURE: Dr. Kalinsky reported financial relationships with 4D Pharma, AstraZeneca, Daiichi Sankyo/AstraZeneca, Genentech/Roche, Immunomedics, Eli Lilly, Menarini Silicon Biosystems, Merck, Mersana Therapeutics, Myovant Sciences, Novartis, Oncosec, Prelude Therapeutics, Puma Biotechnology, Seagen, and Takeda.
The phase II PHERGain trial, which employed a response-adapted strategy in the treatment of early-stage, HER2-positive breast cancer, has shown promising results for the selective use of HER2 blockade and de-escalation of chemotherapy.1 Nearly all patients assigned to skip chemotherapy prior to...