We are here at the JADPRO Live conference in Minneapolis, Minnesota, and I was able to attend some amazing presentations. One that stood out was the discussion on hormone-positive HER2-negative breast cancer across the continuum. This was a packed discussion involving input from the medical oncology, radiation oncology, and surgical oncology perspectives, and reviewed cases of early stage, locally recurrent, and metastatic patients with hormone-positive HER2-negative breast cancer. The key takeaway that I left with is the importance of collaboration from all three specialties, ensuring the best possible outcomes for our patients. I really enjoyed learning more about the surgical and radiation oncology management of our patients since my focus is medical oncology.
A key takeaway from the early-stage management of patients with hormone-positive HER2-negative breast cancer is that endocrine therapy is the mainstay adjuvant therapy. I appreciated that they touched on the trial involving women who had hormone-positive DCIS and took “baby tam,” which is a lower dose of 5 milligram tamoxifen vs placebo.
In this study, there was a 52% reduction in invasive breast cancer or DCIS vs placebo. With respect to the local regional recurrent part of this discussion, I was reminded that mastectomy is the standard of care after having had lumpectomy and breast radiation, as there is a 20 to 30% risk of local recurrence with repeat lumpectomy alone. I enjoyed how the presenters incorporated several key studies and graphics in their presentation as this made it feel more personalized and similar to what we are seeing every day in clinic. The metastatic hormone receptor-positive breast cancer case was something that I was able to relate to, as I see so many of these patients in my own exam room every day.
The important takeaway from this particular case was the importance of genomic testing to see if there are any targetable mutations that can help to guide the systemic therapy plan. For instance, the patient that was presented in this discussion had first-line therapy of a CDK4/6 inhibitor and an aromatase inhibitor, then had progression of disease and ultimately had genomic testing, which showed that she had an ESR1 mutation, which opened the door for her to receive an oral SERD called elacestrant. And she was on this for 6 months before she progressed.
Something that I would like to learn more about, and I'm sure that there'll be studies looking into this, is if we can sequence oral SERDs in the metastatic setting. For instance, can we go from using elacestrant to a different oral SERD like vepdegestrant after a patient experiences progression of disease? I also think that we're going to be seeing more oral SERDs being used in the early-stage adjuvant setting for high-risk hormone-positive disease. Overall, I really enjoyed this presentation as it was a great example of the importance of a multidisciplinary approach to achieve the best possible outcomes for our patients.
