Practice Update | Onology

ASCO 2017 11

Practice changers in breast cancer Interview with Lee S. Schwartzberg MD, FACP Dr Farzanna Haffizulla speaks with Dr Schwartzberg, Executive Director of the West Cancer Center in Memphis, Tennessee, on the OlympiAD trial and its implications for patients with metastatic breast cancer harboring germline BRCA mutations, as well as the CDK4/6 inhibitor abemaciclib for ER-positive metastatic breast cancer. Dr Haffizulla: I would love for you to highlight any key practice changing data that’s pre- sented in the breast cancer arena at this time. Dr Schwartzberg: I think this year in breast cancer there was one overriding story, which was the phase 3 data in OlympiAD, which compared patients to best standard treatment of the physician’s choice in late-line metastatic breast cancer, compared to a novel agent, olaparib, which is a PARP inhibitor. This was selected for patients that had germline BRCA mutations, so this is truly personalized medicine based on a genomic alteration, and the results were positive. The progression-free survival was substantially enhanced by using olaparib versus chemotherapy. This, to me, represents a new standard for patients who have this genetic abnormality, and I will be incorporating it into my practice. Dr Haffizulla: You have been such a grand supporter of precision medicine in all that you do, and we appreciate all of that information that you’re sharing. Anything else for us to look forward to? Any trials that might be ongoing now or any data that might be coming up in the near future that you wanted to draw our attention to? Dr Schwartzberg: I think that the other area of great interest is the CDK4/6 inhibitors. We heard data with abemaciclib at this year’s ASCO, which is also very important, and gives us another opportunity to use abemaciclib in combination with anti-endocrine therapy for metastatic breast cancer that’s ER-positive. So now we have a third agent in the CDK4/6 arena where we can choose, based on toxicities or mode of administration and so forth. So, now we have options for patients with CDK4/6, and I think most of us believe that combination therapy for ER-positive breast cancer, endocrine therapy plus a CDK4/6, for most patients at the diagnosis of metastatic breast cancer will be the way we go.

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© ASCO 2017/David Eulitt

LATITUDE did not, so LATITUDE was purely within the metastatic space and they had some restrictions. You had to have at least three lesions or you could end up with a high Gleason 8, a little bit different entry criteria. The bottom line is, I kind of look at LATITUDE in a way as confirmatory or STAMPEDE as confirmatory. The two really sync together, and together they make a really good story, and the bottom line is that they’re positive, positive, positive for our most important endpoint, overall survival for those with metastatic disease. Dr Haffizulla: Fantastic to hear that. Now, you’ve also reviewed the role of chemo- therapy in prostate cancer based on CHAARTED, as you mentioned, and a previous presentation of STAMPEDE but related to docetaxel. What do you think the role of docetaxel is in the face of the data from LATITUDE and STAMPEDE? Dr Sartor: Well, you know, I mentioned that we have a new standard. I didn’t say the

that that is clearly a benefit for the high vol- ume subset, and for the abiraterone, I think it presents another option. Are we going to compare the two? Well, we need to, or what about combine the two? We need to do that. So, there’s a lot of path forward here and it just really means that men have more options. Dr Haffizulla: So, further research is needed before you can decide. Dr Sartor: Further research is needed, as always.

new standard. So, I chose thosewords care- fully. When we looked at docetaxel, they had a strikingly positive, particularly in the high volume subset based on CHAARTED. There had to be four or more lesions, vis- ceral lesions, things that sort of made the disease bad, and it turns out that when you look at these data together I think it tells you that there are two options. I don’t think we have to go with the docetaxel. I don’t think we have to go with the abiraterone. I think it’s conceivable to say that we’re unsure about which one really might be better. I’ll say that from a side effect per- spective, you know, probably from a safety perspective, the abiraterone might, in fact, be very favourable. But at the same time you have to realize the docetaxel it’s 6 doses and 6 doses only, then you’re done. Whereas the abiraterone you continue the therapy for a much longer period of time. So, there might be some who choose to be treated with chemotherapy, and I think

Farzanna S Haffizulla MD, FACP, FAMWA practices general internal medicine in Davie, Florida, within her own internal medicine concierge practice.

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VOL. 1 • NO. 2 • 2017