19 / 32
Lightning rounds at the
34th Annual Miami Breast
Conference
T
he 34th Annual Miami Breast Conference took place form
March 9–12 in Miami Beach. It ended on Sunday March
12th with the “Lightning rounds” providing an overview
of the conference. The take home messages for metastatic
breast cancer were:
Brainmetastasis
•
In patients with brain metastasis whole brain radiation should
be avoided.
•
If the only site of progression is the brain, patients should
receive local therapy and systemic therapy should not be
changed.
HER2+ breast cancer
•
The demographics of patients with metastatic HER2+ breast
cancer has changed. Higher proportion are de novo meta-
static and hormone receptor positive.
•
The first line treatment for metastatic HER2+ breast cancer
is the combination of a Taxane with Trastuzumab and Per-
tuzumab. The second line is TDM-1 and many options are
available for third line.
Hormone receptor positive breast cancer
•
First line therapy for hormone receptor positive metastatic
breast cancer has changed. Targeted combinations are
superior to their monotherapy comparators.
•
Novel agents in the treatment of hormone receptor positive
breast cancer include mTOR inhibitors (everolimus), CDK
inhibitors (palbociclib, ribociclib, abemaciclib) and PI3K
inhibitors (buparlisib, taselisib).
•
CDK4/6 inhibitors are here to stay. Palbociclib is approved for
first and second line treatment in combination with letrozole
or fulvestrant and Ribociclib will likely be approved this year
in combination with letrozole.
Triple negative breast cancer
•
PARP inhibitors will be an option for patients with BRCA1 or
BRCA2 germline mutations.
•
Olaparib met its primary endpoint in the phase III trial in
BRCA-mutated metastatic breast cancer.
Immunotherapy
•
Recent advances have been made in immunotherapy for
metastatic breast cancer. Combination strategies are needed
to enhance the immune infiltrate and their efficacy.
Androgen receptor
•
Based on the encouraging phase II data, studies targeting the
androgen receptor are ongoing in both estrogen receptor
positive and negative breast cancer.
Diagnostics
•
Assays with circulating tumor cells and circulating tumor DNA
are not ready for prime time and routine use.
•
Combination of biomarkers are critical to future studies.
PracticeUpdate Editorial Team
The MONALEESA-2 was a phase III clinical trial that randomized
668 postmenopausal women with hormone receptor positive,
HER2-negative recurrent or metastatic breast cancer who had not
received previous systemic therapy for advanced disease to ribo-
ciclib in combination with letrozole versus ribociclib plus placebo.
The progression free survival was significantly longer in the ribo-
ciclib group with a statistical significant hazard ratio of 0.56. With
this results probably ribociclib will we approve this year.
Finally, MONARCH 1, a phase 2 single-arm study showed that the
selective CDK4 and CDK6 inhibitor abemaciclib used as a sin-
gle agent induced objective tumor responses as monotherapy in
patients with refractory hormone receptor-positive breast cancer
that have failed multiple prior therapies. Even though this study did
not meet the predefined objective response rate, 42% of women
had clinical benefit. Data has also shown that abemaciclib crosses
the blood-brain barrier.
The toxicity profile of this agents differs in that palbociclib and
ribociclib cause more neutropenia and that abemaciclib causes
more abdominal pain and diarrhea. We need to refer patients to
clinical trials to learn how to use them and which patient popula-
tion will benefit from these agents.
PracticeUpdate Editorial Team
MBCC 2017
19
VOL. 1 • NO. 1 • 2017