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effect from the first 5 years of endocrine
therapy, some patients still develop recurrent
disease once they stop endocrine therapy, and
we call these recurrences “late” as they happen
in years 5 to 10, and even beyond.
There are several diagnostic assays that help
us identify risk of recurrence. The Oncotype
DX assay does a great job in predicting overall
10-year risk of recurrence and benefit with
chemotherapy; but, when we home in on
that late time period (from 5 to 10 years),
it’s not useful to help identify which patients
will have a late relapse and it is not helpful
to use Oncotype to make decisions about
extending endocrine treatment. This is where
some of these other assays come in to play,
like the Prosigna assay, which does identify a
patient’s late risk of recurrence, and also the
Breast Cancer Index. The difference between
Prosigna and the Breast Cancer Index is that
the Breast Cancer Index is quite useful in
not only providing an individualised risk of
late recurrence, but it also provides predictive
information of whether or not extending
endocrine therapy would be beneficial.
I think that the issue with all of these assays is
that we need more datasets to validate them.
The data are evolving, and we are certainly
learning how to incorporate these assays into
our decision-making process.
Haematology practice implications: newHodgkin’s
lymphoma research
INTERVIEW WITH ANDRE GOY MD
Dr Goy, Chairman and Director, and Chief of
Lymphoma at the John Theurer Cancer Center,
Hackensack University Medical Center, New
Jersey, discusses the latest research presented
on Hodgkin’s lymphoma
presented at this year’s ASCO
meeting.
Immunotherapy in RCC: an overview of key new data
fromASCO
INTERVIEW WITH ERIC JONASCH MD
Dr Jonasch, Professor in the Department of
Genitourinary Medical Oncology, Division
of Cancer Medicine at the MD Anderson
Cancer Center of The University of Texas in
Houston, shares his insights
on immunotherapy in renal
cell carcinoma and new data
presented at ASCO 2016.
Lack of noninferiority of docetaxel +
cyclophosphamide to anthracycline/
taxane-based chemotherapy
regimens
Another take-away point for me was
in the adjuvant setting. The ABC trial
3
was an evaluation of the use of a non-
anthracycline regimen, TCx6, versus a
standard anthracycline/taxane regimen.
Somewhat surprisingly, TC was not found
to be noninferior. Exploratory subgroup
analyses showed a benefit of anthracyclines
and taxanes in ER-positive patients with
positive nodes, and in ER-negative patients
who were node-positive or deemed high-risk
node-negative. In ER-positive, node-negative
patients, I think that TC is certainly still a
reasonable regimen.
I think we all hoped that TCx6 would have
been proven to be equivalent; unfortunately,
that wasn’t the case. Anthracycline-based
therapy is still a mainstay of treatment for
several groups of patients.
Selecting patients for different
neoadjuvant therapies
The two situations in which we most
often incorporate the use of neoadjuvant
chemotherapy in breast cancer patients are
in patients who have HER2-positive disease
and in those with triple-negative disease.
We noticed that in those two patient subsets
chemotherapy tends to be quite effective,
and, in the HER2-positive subset, with the
addition of anti-HER2 therapy as well. We
have a controversy surrounding the addition
of carboplatin in the treatment of triple-
negative patients. Two studies presented at
SanAntonio last year had somewhat different
results in terms of the benefit of carboplatin
for improvement in event-free survival;
however, certainly both studies showed
an improvement in pathologic complete
response.
In patients with HER2-positive disease, the
use of neoadjuvant pertuzumab for larger
tumours and for node-positive disease has
become quite standard. It is really changing
the natural history of the disease in that our
neoadjuvant and adjuvant approaches are
resulting in fewer recurrences. For those who
do develop metastatic disease, we have seen
significant improvements in survival with the
addition of HER2-targeted therapies such as
pertuzumab and T-DM1.
Putting results of genomic testing to
clinical advantage
What we refer to as next-generation
sequencing or genomic testing – looking at
differences either in the tumour or in the
microenvironment that would change the
behaviour of the disease – is quite different
from testing for a genetic predisposition for
developing breast cancer. Patients tend to get
confused quite a bit about the differences
between the two. However, we’re not really
in the situation where we can routinely
incorporate the information that we get from
genomic profiling, and, of course, attempting
to answer these questions is always encouraged
in the context of a clinical trial. I think the
science is somewhat ahead of the data, but the
information is becoming increasingly useful;
for example, the story of ESR1 mutations in
ER-positive patients.
References
1. Goss PE, Ingle JN, Pritchard KI, et al. Paper
presented at: 2016 Annual Meeting of the
American Society of Clinical Oncology; June
3-7, 2016; Chicago, IL. Abstract LBA1.
2. Finn RS, Martin M, Rugo HS, et al. Paper
presented at: 2016 Annual Meeting of the
American Society of Clinical Oncology; June
3-7, 2016; Chicago, IL. Abstract 507.
3. Blue JL, Flynn PJ, Yothers G, et al. Paper
presented at: 2016 Annual Meeting of the
American Society of Clinical Oncology; June
3-7, 2016; Chicago, IL. Abstract 1000.
ASCO 2016
15
DECEMBER 2016