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This is Part 2 of Targeting Endocrine Resistance in HR-Positive/HER2-Negative Metastatic Breast Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this Roundtable. In this video, Drs. Kevin Kalinsky, Manali Bhave, and Ruth O’Regan discuss the treatment of hormone receptor–positive, HER2-negative metastatic breast cancer with a PIK3CA mutation. The patient is a 62-year-old postmenopausal female who is diagnosed with invasive ductal carcinoma that is metastatic to lung, liver, and bone. Her tumor is ER and PR strongly positive and HER2-low. After 12 months of treatment with ribociclib plus an aromatase inhibitor, she has progressive disease in her liver. Biomarker testing reveals a pathogenic PIK3CA H1047R mutation. The faculty discuss how PIK3CA and AKT pathway alterations impact treatment decision making, the clinical implications of the CAPItello-291 study, and how to approach patients who do not have targetable mutations.
This is Part 1 of Targeting Endocrine Resistance in HR-Positive/HER2-Negative Metastatic Breast Cancer, a three-part video roundtable series. Scroll down to watch the other videos from this Roundtable. In this video, Drs. Kevin Kalinsky, Manali Bhave, and Ruth O’Regan discuss the treatment of metastatic hormone receptor–positive, HER2-negative, ESR1-mutated breast cancer after progression on a CDK4/6 inhibitor and endocrine therapy. The patient is a 42-year-old premenopausal healthy female originally diagnosed with grade 2 invasive ductal carcinoma that is ER and PR strongly positive and HER2 0. She receives ribociclib plus an aromatase inhibitor and develops progressive disease after almost 3 years on therapy. Genetic testing reveals a pathogenic ESR1 Y537S mutation. In the conversation that follows, the faculty discuss the role of single-agent elacestrant in patients with acquired ESR1 mutations, the impact of prior treatment duration on second-line therapy, and whether combination strategies should be considered.
Investigators may have uncovered the social determinants of health hindering breast cancer screening in the United States, according to a recent systematic review published by Jhumkhawala et al in Frontiers in Public Health. Background Health disparities have consistently been associated with...
In a study reported in the Journal of Clinical Oncology, Woriax et al identified racial/ethnic differences in pathologic complete response rates and overall survival among women with triple-negative breast cancer who received neoadjuvant chemotherapy. Study Details The study involved data from the...
In an analysis reported in JAMA Network Open, Jacob K. Kresovich, PhD, and colleagues identified differences in circulating leukocyte subsets between women who were diagnosed and treated for breast cancer vs those not diagnosed with breast cancer. As stated by the investigators: “Changes in...
Investigators have found that U.S. individuals with a history of incarceration may have worse access to and receipt of breast cancer and colorectal cancer screenings compared with those without a history of incarceration, according to a recent study published by Zhao et al in JAMA Health Forum....
In a Dutch study reported in the Journal of Clinical Oncology, Neppelenbroek et al found that doxorubicin treatment was associated with an increased risk of breast cancer among adolescent and adult Hodgkin lymphoma survivors. Study Details The study involved a cohort of 1,964 female 5-year Hodgkin...
Studies presented at the 2023 San Antonio Breast Cancer Symposium (SABCS) significantly moved the needle forward in our treatment of breast cancer. We are increasingly learning how to stratify risk, so we can optimize therapy and minimize our patients’ exposure to treatments that will not be...
Although current ASCO guidelines recommend exercise for patients with breast cancer during adjuvant therapy with curative intent, the guidelines state that more study is needed regarding the effects of exercise for patients with metastatic breast cancer. The results of the PREFERABLE-EFFECT trial...
It may be possible for some patients with breast cancer to avoid adjuvant regional nodal irradiation safely, according to the results of the NRG Oncology/NSABP B-51/RTOG 1304 clinical trial presented at the 2023 San Antonio Breast Cancer Symposium.1 These findings particularly apply to patients...
Investigators used low recurrence scores on a genomic assay as guidance for selection of favorable-risk patients, and they found most postmenopausal patients (aged 50–69) with stage I hormone receptor–positive breast cancer who omitted adjuvant radiation therapy but continued endocrine therapy for...
Invited discussant Laura Huppert, MD, of the University of California, San Francisco, Comprehensive Cancer Center, focused her remarks on the need for biomarkers for selection of immunotherapy as part of neoadjuvant chemotherapy for hormone receptor–positive, HER2-negative breast cancer. “Hormone...
Pembrolizumab added to neoadjuvant chemotherapy followed by adjuvant pembrolizumab plus endocrine therapy improved pathologic complete responses in patients with early-stage, high-risk, estrogen receptor (ER)-positive, HER2-negative breast cancer, according to updated results of the phase III...
At a median follow-up of 8.4 years, adjuvant use of ado-trastuzumab emtansine (T-DM1) continued to improve invasive disease–free survival and overall survival compared with trastuzumab in patients with HER2-positive early breast cancer with residual invasive disease after neoadjuvant therapy. These ...
Heather Han, MD, Research Director, Department of Breast Oncology, Moffitt Cancer Center, Tampa, commented on the latest update from the NATALEE trial: “Despite the established standard adjuvant therapy, many patients with hormone receptor–positive, early-stage breast cancer (including stages...
Invasive disease–free survival continued to be significantly improved for patients with hormone receptor–positive, HER2-negative, early-stage breast cancer who received the CDK4/6 inhibitor ribociclib plus a nonsteroidal aromatase inhibitor compared with a nonsteroidal aromatase inhibitor alone....
The addition of inavolisib to first-line treatment with palbociclib plus fulvestrant more than doubled progression-free survival in patients with recurrent PIK3CA-mutated, hormone receptor–positive, HER2-negative advanced breast cancer, according to a late-breaking primary analysis of the phase III ...
Adding the antibody-drug conjugate ado-trastuzumab emtansine (T-DM1) to the HER2-targeted agent tucatinib extended progression-free survival by about 2 months vs treatment with T-DM1 alone among patients with unresectable, locally advanced or metastatic HER2-positive breast cancer, according to...
In a long-term analysis of the EORTC 10041/BIG 03-04 MINDACT trial reported in the Journal of Clinical Oncology, Alaeikhanehshir et al found that the 70-gene signature was not independently predictive of locoregional recurrence among women undergoing breast-conserving surgery for early breast...
Investigators used low recurrence scores on a genomic assay as guidance for selection of favorable-risk patients, and they found most postmenopausal patients (aged 50–69) with stage I hormone receptor–positive breast cancer who omitted adjuvant radiation therapy but continued endocrine therapy for...
In a phase II trial (Study G200802) reported in The Lancet Oncology, Palmieri et al found that the novel selective androgen receptor (AR) modulator enobosarm was active in previously treated patients with AR-positive, estrogen receptor (ER)-positive, HER2-negative locally advanced or metastatic...
As reported in the Journal of Clinical Oncology by Charles E. Geyer Jr, MD, and colleagues, long-term follow-up of the ABC trials (USOR 06-090, NSABP B-46-I/USOR 07132, and NSABP B-49 [NRG Oncology]) showed that noninferiority of adjuvant nonanthracycline therapy was not demonstrated vs...
In a Dutch study (HONEY) reported in JAMA Oncology, van der Molen et al found that patients with breast cancer and late local toxic effects after adjuvant radiotherapy who completed hyperbaric oxygen therapy (HBOT) had reductions in pain and fibrosis. However, only a minority of patients offered...
Investigators have found that annual breast cancer screening beginning at age 40 and continuing to at least 79 may result in the greatest reduction in mortality with minimal risks, according to a recent study published by Monticciolo et al in Radiology. Background Breast cancer is the second most...
In a Swedish study reported in JAMA Oncology, Rodriguez et al identified characteristics of interval breast cancers—those diagnosed between two screening examinations—compared with screen-detected cancers on the basis of analysis of rare germline genetic deleterious protein-truncating variants. As...
Investigators have found that risk-reducing mastectomy decreases the risk of receiving a breast cancer diagnosis and the likelihood of mortality in female patients with BRCA1 or BRCA2 genetic variants, according to a recent study published by Metcalfe et al in the British Journal of Cancer....
In a patient-reported outcomes analysis from the phase III OlympiA trial reported in the Journal of Clinical Oncology, Patricia A. Ganz, MD, FASCO, and colleagues found no clinically important differences in fatigue—the outcome of primary interest—between adjuvant olaparib and placebo in patients...
A novel three-drug combination achieved notable responses in patients with advanced HER2-negative breast cancer, according to new research published by Roussos Torres et al in Nature Cancer. The regimen included a histone deacetylase (HDAC) inhibitor combined with two types of checkpoint...
In a Chinese single-institution phase II trial (FUTURE-SUPER) reported in The Lancet Oncology, Fan et al found that molecular subtype–based therapy produced promising results in the first-line treatment of metastatic or recurrent triple-negative breast cancer. Study Details In the open-label...
In a phase III trial reported in JAMA Oncology, Cynthia X. Ma, MD, PhD, and colleagues found that neither neoadjuvant fulvestrant nor anastrozole plus fulvestrant improved the endocrine-sensitive disease (ESD) rate vs anastrozole alone among postmenopausal patients with phase II to III estrogen...
In a study reported in JAMA Network Open, Xu et al identified incidence of primary invasive breast cancer according to race/ethnicity, disease stage, and hormone receptor status among U.S. women with breast cancer aged 20 to 49 years diagnosed between 2000 and 2019. Study Details The study used...
Low-dose positron-emission mammography (PEM) may provide high sensitivity for detecting breast cancer and significantly reduce the likelihood of false-positive results, according to a recent study published by Freitas et al in Radiology: Imaging Cancer. The innovative breast imaging technique may...
Researchers may have uncovered the factors contributing to hormone therapy resistance in some patients with advanced estrogen receptor (ER)-positive breast cancer, according to a recent study published by Kingston et al in Cancer Discovery. The findings may indicate drugs currently in development...
In a German single-institution study reported in JAMA Oncology, Hülpüsch et al identified skin microbiome characteristics associated with severe radiodermatitis in women receiving adjuvant radiotherapy for breast cancer. Study Details The study included 20 consecutively enrolled women who received...
Investigators have uncovered high rates of reoperation following initial breast-conserving surgery in patients with breast cancer that may contribute to increased costs of cancer care and a higher risk of postoperative complications, according to a recent study published by Kim et al in the Annals...
As reported in the Journal of Clinical Oncology by Dennis J. Slamon, MD, PhD, and colleagues, the phase III PALOMA-2 trial showed no overall survival benefit with the addition of palbociclib to letrozole in patients with estrogen receptor (ER)-positive, HER2-negative advanced breast cancer with no...
Invited discussant Laura Huppert, MD, of the University of California, San Francisco, Comprehensive Cancer Center, focused her remarks on the need for biomarkers for selection of immunotherapy as part of neoadjuvant chemotherapy for hormone receptor–positive, HER2-negative breast cancer. “Hormone...
Pembrolizumab added to neoadjuvant chemotherapy followed by adjuvant pembrolizumab plus endocrine therapy improved pathologic complete responses in patients with early-stage, high-risk, estrogen receptor (ER)-positive, HER2-negative breast cancer, according to updated results of the phase III...
Heather Han, MD, Research Director, Department of Breast Oncology, Moffitt Cancer Center, Tampa, commented on the latest update from the NATALEE trial: “Despite the established standard adjuvant therapy, many patients with hormone receptor–positive, early-stage breast cancer (including stages...
Invasive disease–free survival continued to be significantly improved for patients with hormone receptor–positive, HER2-negative, early-stage breast cancer who received the CDK4/6 inhibitor ribociclib plus a nonsteroidal aromatase inhibitor compared with a nonsteroidal aromatase inhibitor alone....
The road to my breast cancer diagnosis in 2018 was long and tortuous. For 3 years leading up to the diagnosis, I had imaging scans and tissue biopsies every 3 months because of suspicious masses in my breasts. The uncertainty was so destabilizing that I was in a constant state of emotional unrest....
As reported in the Journal of Clinical Oncology by Priya Rastogi, MD, and colleagues, an interim analysis of overall survival in the phase III monarchE trial showed no significant benefit with the addition of 2 years of adjuvant abemaciclib to endocrine therapy in patients with hormone...
The addition of inavolisib to first-line treatment with palbociclib plus fulvestrant more than doubled progression-free survival in patients with recurrent PIK3CA-mutated, hormone receptor–positive, HER2-negative advanced breast cancer, according to a late-breaking primary analysis of the phase III ...
Hope S. Rugo, MD, of the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses data from the phase II KEYLYNK-009 study, which compared pembrolizumab plus olaparib vs pembrolizumab plus chemotherapy after induction with pembrolizumab plus chemotherapy for patients with locally recurrent inoperable or metastatic triple-negative breast cancer (Abstract GS01-05).
Reshma Jagsi, MD, DPhil, of Emory University Winship Cancer Institute, discusses the IDEA trial of endocrine therapy without radiotherapy after breast-conserving surgery for postmenopausal patients between the ages of 50 and 69 with stage I breast cancer. The regimen demonstrated a low risk of relapse in this population, with a genomic assay used in combination with classic clinical and biological features for treatment selection (Abstract GS02-08).
Seema Khan, MD, of Northwestern University and the Robert H. Lurie Comprehensive Cancer Center, discusses the 5-year clinical outcomes of ECOG-ACRIN 4112, a prospective trial that supports the omission of radiotherapy after surgery in patients with ductal carcinoma in situ who have a low DCIS score and its use in patients with intermediate/high DCIS scores (Abstract GS03-01).
In 2023, nearly 300,000 new cases of invasive breast cancer were diagnosed in the United States, and approximately 56,000 new cases of ductal carcinoma in situ were diagnosed. Although most of those cancers are diagnosed in older adults, about 9% of all new cases of breast cancer are found in women ...
In a retrospective analysis reported in JAMA Oncology, Bolze et al identified a group of women at low risk for breast cancer based on genetic analysis. The findings may support altering cancer screening in this low-risk group. As stated by the investigators, “Genetic information is not being used...
Researchers may have uncovered a novel strategy to predict whether synthetic chemicals may cause breast cancer by examining their specific traits, according to a recent study published by Kay et al in Environmental Health Perspectives. Background The incidence of breast cancer—the most common...
At a median follow-up of 8.4 years, adjuvant use of ado-trastuzumab emtansine (T-DM1) continued to improve invasive disease–free survival and overall survival compared with trastuzumab in patients with HER2-positive early breast cancer with residual invasive disease after neoadjuvant therapy. These ...